Actinomyces are anaerobic, Gram-positive bacteria that are part of the endogenous flora of mucous membranes in humans. Infection caused by these bacteria is termed actinomycosis. The 3 most common types of actinomycosis are cervicofacial, abdominopelvic, and pulmonary. A previously healthy 6-year-old boy presented with the emergency room with fever, vomiting, and abdominal pain and initially diagnosed with acute appendicitis. Exploratory laparoscopy was done. Histologic finding demonstrated acute gangrenous appendicitis complicated by perforation and sulfur granules compatible with actinomycosis. Subsequently, he was diagnosed with abdominal actinomycosis and received long-term antibiotic therapy. Abdominal actinomycosis is uncommon in children and difficult to diagnose because of its nonspecific symptoms and of difficulties in growing Actinomyces in the clinical setting. It is necessary to include abdominal actinomycosis as a differential diagnosis of children presenting with abdominal pain.
Abdomen ; Abdominal Pain ; Actinomyces ; Actinomycosis ; Appendicitis ; Bacteria ; Child ; Diagnosis, Differential ; Emergency Service, Hospital ; Fever ; Gram-Positive Bacteria ; Humans ; Laparoscopy ; Male ; Mucous Membrane ; Sulfur ; Vomiting

We experienced a case of acute pyelonephritis which progressed to Escherichia coli bacteremia and later complicated by empyema in a 65-year-old female. She was successfully treated with intravenous antibiotic therapy and percutaneous drainage of empyema.
Aged ; Bacteremia ; Drainage ; Empyema ; Escherichia ; Escherichia coli ; Female ; Humans ; Pyelonephritis

We experienced a case of acute pyelonephritis which progressed to Escherichia coli bacteremia and later complicated by empyema in a 65-year-old female. She was successfully treated with intravenous antibiotic therapy and percutaneous drainage of empyema.
Aged ; Bacteremia ; Drainage ; Empyema ; Escherichia ; Escherichia coli ; Female ; Humans ; Pyelonephritis

BACKGROUND: T-cell mediated cellular immunity has been suggested as an important mechanism in mycobacterial infection. Also, it is known that there is a imbalance between helper and suppressor T cells in the pathogenesis of tuberculosis in human. This study was designed to evaluate the changes of lymphocyte subsets in patients with pulmonary and extrapulmonary tuberculosis. METHODS: Lymphocyte subset analysis was performed on 53 pulmonary tuberculosis and 21 extrapulmonary tuberculosis patients. The proportion of total T (CD3+), B (CD19+), helper T (H, CD3+CD4+) and suppressor T (S, CD3+CD8+) cells, natural killer (NK, CD16+CD56+) cells and activated T (CD3+HLA-DR+) cells were analyzed using SimultestTM (Becton-Dickinson, California, USA) by FACSortTM (Becton-Dickinson, California, USA) and each absolute cell counts and helper T/suppressor T (H/S) ratio were calculated. RESULTS: In pulmonary and extrapulmonary tuberculosis patients groups, there were no significant changes in percentage and absolute cell counts of lymphocyte subset compared to control group. But H/S ratio was significantly decreased in both groups and the H/S ratio in extapulmonary tuberculosis was lower than that in pulmonary tuberculosis (1.06+/-0.44 vs. 1.64+/-0.97). CONCLUSION: Decreased or reversed H/S ratio reflect the role of cell mediated immune response in patients with tuberculosis, expecially in the spreading of pulmonary tuberculosis. Lymphocyte subset test seems to be helpful for access the different clinical forms of tuberculosis, pulmonary and extapulmonary tuberculosis.
California ; Cell Count ; Humans ; Immunity, Cellular ; Killer Cells, Natural ; Lymphocyte Subsets* ; Lymphocytes* ; T-Lymphocytes ; Tuberculosis* ; Tuberculosis, Pulmonary

OBJECTIVE: Chronic subdural hematoma (CSDH) is known to have a significant recurrence rate. There are different criteria defining the recurrence of CSDH. We evaluated the postoperative course of CSDH and tried to propose the reasonable criteria of recurrence. METHODS: We retrospectively examined the medical records and pre- and postoperative CT scans of 149 consecutive patients who underwent surgery from January 2005 to December 2009. Diagnosis was confirmed by CT scanning or MRI. The postoperative courses were either resolved or recurrent. The resolved CSDH was one of the three types; early resolution, delayed resolution, or late resolution. The recurrent CSDH was one of the four types; recurrence without resolution, early recurrence after resolution, late recurrence after resolution, or recurrent-and-resolved type. RESULTS: The CSDH was resolved within 30 days after surgery in 58 (39%) patients, between 1 to 3 months in 62 (42%), and after 3 months in 11 (7%) patients. The CSDH was recurred in 18 (12%) patients. Late resolution or recurrence was more common in the aged. The recurrent hematoma was seen on the same side in 11 patients, on the different side in 7 patients. Recurrence was significantly more common in the thick hematomas. CONCLUSION: For a working criteria of the recurrence of CSDH, we propose the early recurrence as return of symptoms or reaccumulation of the hematoma after a surgery within 3 months regardless of the location, amount or repeated operations. The late recurrence can be defined as reappearance or enlargement of a liquefied hematoma within the cranial cavity surrounded by the membranes or persistent CSDH beyond 3 months after surgery.
Aged ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Medical Records ; Membranes ; Recurrence ; Retrospective Studies ; Risk Factors

Large pituitary adenomas causing Cushings disease are uncommon, and usually present with mild manifestations of Cushings syndrome. Large adenomas may have rapid growth and quickly reach a size large enough to become clinically apparent. These tumors are more frequently invasive than microadenomas, their widespread extensions make radical surgical removal difficult and the ultimate clinical course malignant. We report a case of 37 year-old women presenting amenorrhea, weight gain, and moon face. Sellar magnetic resonance imaging(MRI) demonstrated a large lobulating tumor measuring 3.5cm in diameter, arising from sella turcica, extending up to suprasellar area and invading the cavernous sinuses. Transfrontal adenectomy was performed to remove a mass, but residual mass was remained after surgery. Subsequent external brain radiotherapy(total dose 5400cGy) was performed. Histology revealed an adrenocorticotrophin(ACTH) secreting pituitary adenoma. After treatment, her menstration was started, body weight was reduced, and moon face was disappeared.
Adenoma ; Adult ; Amenorrhea ; Body Weight ; Brain ; Cavernous Sinus ; Female ; Humans ; Pituitary Neoplasms* ; Radiotherapy* ; Sella Turcica ; Weight Gain

Isolated fetal ascites may be different from general category of nonimmune hydrops in both prenatal course and prognosis. We experienced one case of isolated fetal ascites of unknown origin treated by in utero ultrasound-directed paracentesis and so present it with brief review of literature.
Ascites* ; Edema ; Paracentesis* ; Prognosis

BACKGROUND: Life style has been shown to improve risk factors comprising the metabolic syndrome. Metabolic syndrome is a prime candidate for lifestyle modification utilizing the tools of exercise, nutritional therapy and so on. Therefore, we examined the prevalence of metabolic syndrome according to health behaviors. METHODS: A total of 1,240 adults were recruited into this cross-sectional study. The subjects were examined on body mass index, waist circumference, blood pressure, and lipid profile. Medical history was reviewed and daily calorie intake was examined by food frequency questionnaire. Six healthy behaviors, sleeping hours, smoking, drinking, exercise, calorie intake and body weight of subjects, were examined. Each healthy behaviors were categorized into three groups. Metabolic syndrome as diagnosed by ATP III criteria. RESULTS: The study subjects consisted of 57.1% men and 42.9% women. The prevalence of metabolic syndrome was 14.3%. The prevalence of metabolic syndrome was lower in the group with good healthy behaviors. The subjects with more good healthy behaviors had a lower prevalence of metabolic syndrome than those with less good healthy behaviors (0, 50.0%; 1, 41.0%; 2, 30.6%; 3, 13.8%; 4, 8.5%; 5, 5.3%; and 6, 4.3%). Relative to the subjects with high good health behavior score, those with low good health behavior score were at significantly increased risk of metabolic syndrome (odds ratio = 4.25, 95% CI 2.97-6.08). CONCLUSION: The subjects with much more good healthy behaviors had a substantially lower risk of being diagnosed with the metabolic syndrome compared to those with lesser good healthy behaviors. This finding suggests that lifestyle modification may be appropriate as the first-line intervention to metabolic syndrome.
Adenosine Triphosphate ; Adult ; Blood Pressure ; Body Mass Index ; Body Weight ; Cross-Sectional Studies ; Drinking ; Female ; Health Behavior ; Humans ; Life Style ; Male ; Prevalence ; Risk Factors ; Smoke ; Smoking ; Waist Circumference ; Surveys and Questionnaires

Metastatic thyroid papillaty carcinoma was diagnosed in a 54-year-old woman. The cancer had present in many lymph nodes. After her surgical procedure, she was advised to have radioiodine treatment. However, the patient had chronic renal failure and was on hemodialysis. We tried radioiodine therapy of usual dose for remove of residual tumor burden. Hemodialysis treatments of 4hours and 2 hours performed each 24 and 48 hours after the administration of 131I resulted in a 66% and 80% reduction in total body radiation levels. All contaminated wastes were disposed of by the hospital's department of radiation safety. Postdialysis monitoring revealed no residual radiation contamination of dialysis machines or radiation exposure to the dialysis staff. It is needed more experiences about dose of radioiodine and timing, blood flow rate and duration of hemodialysis.
Carcinoma, Papillary* ; Dialysis ; Female ; Humans ; Kidney Failure, Chronic* ; Lymph Nodes ; Middle Aged ; Neoplasm, Residual ; Renal Dialysis* ; Thyroid Gland*

Purpose: Liver fibrosis plays an important role in the development of hepatocellular carcinoma (HCC) and determining its prognosis. Although many staging systems and liver reserve models have been developed without the intention of predicting prognosis of HCC, some studies have investigated their prognostic values in HCC after curative liver resection (LR). The aim of this study is to evaluate prognostic value of non-invasive biomarkers after curative LR. Methods: Between 2006 and 2013, HCC patients underwent LR were included and total 962 patients were enrolled. All non-invasive biomarkers (fibrosis 4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), AAR-to-platelet ratio index (AARPRI), and albumin-bilirubin (ALBI) score) were measured at the time of HCC diagnosis. To binarize each biomarker, an optimal cut-off value for fibrosis stage was selected using the value of minimum distance from the left-upper corner of the receiver operating characteristic curve with a specificity >60%. We performed Cox regression analysis on 2-year recurrence-free survival (RFS) and overall survival (OS). Results: The area under curve values for FIB-4 and APRI were the largest for fibrosis stage compared to other biomarkers, 0.669 (95% confidential interval (CI), 0.610–0.719) and 0.748 (95% CI, 0.692–0.800), respectively. Between those two indices, FIB-4 is considered a statistically significant prognostic factor of RFS in HCC patients after LR. The HR for 2-year RFS and OS were 1.81 (95% CI, 1.18–2.77; P = 0.007) and 2.36 (95% CI, 0.99–5.65; P = 0.054), respectively. Conclusion FIB-4 is identified as a statistically significant predictor of HCC prognosis after curative LR even in HBV dominant populations.