STUDY DESIGN: Case report. OBJECTIVES: To report a case of epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis. SUMMARY OF LITERATURE REVIEW: An early surgical intervention for acute epidural hematoma following cervical spinal fracture led to improvements in the patient's neurological deficits. MATERIALS AND METHODS: A 76-year-old male with ankylosing spondylitis presented with neck pain and motor weakness of both upper and lower extremities after falling. He sustained fractures of the C7 body and the spinous processes of C5 and C6. Magnetic resonance imaging showed an extensive epidural hematoma from C7 to T5. The authors performed decompression from C6 to T2, and posterior instrumentation and fusion from C4 to T3. RESULTS: An urgent surgical intervention was performed, and a good result was obtained. CONCLUSIONS: The authors describe an early surgical intervention in a case of acute epidural hematoma following cervical spinal fracture in a patient with ankylosing spondylitis.
Accidental Falls ; Aged ; Decompression ; Hematoma* ; Humans ; Lower Extremity ; Magnetic Resonance Imaging ; Male ; Neck Pain ; Spinal Fractures* ; Spondylitis, Ankylosing*

PURPOSE: The aim of this study was to examine molecular subtype conversions in patients who underwent neoadjuvant chemotherapy (NAC) and analyze their clinical implications. MATERIALS AND METHODS: We included consecutive breast cancer patients who received NAC at the National Cancer Center, Korea, between August 2002 and June 2011, and had available data on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) receptor status prior to NAC. Molecular subtypes, hormone receptor (HR) status, and ER and PR Allred scores before and after NAC were compared, and the long-term outcomes were analyzed. RESULTS: Of 322 patients, 32 (9.9%) achieved a pathologic complete response after NAC. HR+/HER2- tumors tended to convert into triple negative (TN) tumors (10.3%), whereas 34.6% of TN tumors gained HR positivity to become HR+/HER2- tumors. Clinical outcomes of molecular subtype conversion groups were compared against patients who remained as HR+/HER2- throughout. The HR+/HER2- to TN group had significantly poorer recurrence-free survival (RFS) (hazard ratio, 3.54; 95% confidence interval [CI], 1.60 to 7.85) and overall survival (OS) (hazard ratio, 3.73; 95% CI, 1.34 to 10.38). Patients who remained TN throughout had the worst outcomes (for RFS: hazard ratio, 3.70; 95% CI, 1.86 to 7.36; for OS: hazard ratio, 5.85; 95% CI, 2.53 to 13.51), while those who converted from TN to HR+/HER2-showed improved comparable survival outcomes. CONCLUSION: Molecular subtypes of breast cancers changed frequently after NAC, resulting in different tumor prognostication. Tumor subtyping should be repeated after NAC in patients with breast cancer.
Breast Neoplasms ; Breast* ; Drug Therapy* ; Epidermal Growth Factor ; Estrogens ; Humans ; Korea ; Receptors, Progesterone

Methods about removal of intramedullary nail in complicated cases were reported in some literatures but there are no reports about nail removal in the ulna. The authors would like to report such a case and the technique. We removed bone of the inlet site and created another bony window using an osteotome to expose the interlocking screw holes. Only a bony window the size of 2 inter-interlocking holes at the most proximal part of the nail can be used to remove the nail with minimal damage of the triceps brachii tendon and soft tissue.
Bays ; Device Removal ; Fracture Fixation, Intramedullary ; Tendons ; Ulna

Methods about removal of intramedullary nail in complicated cases were reported in some literatures but there are no reports about nail removal in the ulna. The authors would like to report such a case and the technique. We removed bone of the inlet site and created another bony window using an osteotome to expose the interlocking screw holes. Only a bony window the size of 2 inter-interlocking holes at the most proximal part of the nail can be used to remove the nail with minimal damage of the triceps brachii tendon and soft tissue.
Bays ; Device Removal ; Fracture Fixation, Intramedullary ; Tendons ; Ulna

BACKGROUND: The effectiveness of prostate-specific antigen (PSA) for population screening has presented controversial results in large trials and prior reviews. We investigated the effectiveness of PSA population screening in a systematic review. METHODS: The study was conducted using existing systematic reviews. We searched Ovid MEDLINE, Embase, Cochrane library, and the major Korean databases. The quality of the systematic reviews was assessed by two reviewers independently using AMSTAR. Randomized controlled trials were assessed using the risk of bias tool in the Cochrane group. Meta-analyses were conducted using Review Manager. The level of evidence of each outcome was assessed using GRADE. RESULTS: Prostate-cancer-specific mortality was not reduced based on similar prior reviews (relative risk [RR] 0.93; 95% confidence interval [CI], 0.81-1.07, P=0.31). The detection rate of stage 1 prostate cancer was not greater, with a RR of 1.67 (95% CI, 0.95-2.94) and high heterogeneity. The detection rate of all cancer stages in the screening group was high, with a RR of 1.45 (95% CI, 1.13-1.85). No difference in all-cause mortality was observed between the screening and control groups (RR, 0.99; 95% CI, 0.98-1.01, P=0.50). Prostate-cancer-specific mortality, all-cause mortality, and diagnosis of prostate cancer at stages 3-4 showed moderate levels of evidence. CONCLUSIONS: Differently from prior studies, our review included updated Norrkoping data and assessed the sole effect of PSA testing for prostate cancer screening. PSA screening alone did not increase early stage prostate cancer detection and did not lower mortality.
Clinical Trials as Topic ; Databases, Factual ; Humans ; Male ; Mass Screening ; Neoplasm Staging ; Prostate-Specific Antigen/*analysis ; Prostatic Neoplasms/*diagnosis/mortality

Infective endocarditis is a dreaded complication in dialysis or kidney transplantation patients, with high morbidity and mortality. Despite the improved early survival of the transplanted kidney with new immunosuppressive agents, the number of patients returning to dialysis after a failed renal allograft is increasing. There is no consensus on the optimal management of immunosuppression in patients with a failed allograft. Continued immunosuppression is associated with infection, and the rapid discontinuation of immunosuppression may lead to acute rejection. Therefore, it is important to taper the immunosuppression properly in patients with a failed renal allograft. We report on a hemodialysis patient with a failed renal allograft who had a cerebral infarction following infective endocarditis. The patient was treated successfully with antibiotics and valve replacement.
Anti-Bacterial Agents ; Cerebral Infarction ; Consensus ; Dialysis ; Endocarditis ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Kidney ; Kidney Transplantation ; Rejection (Psychology) ; Renal Dialysis ; Transplantation, Homologous ; Transplants

OBJECTIVE: Current guidelines for initiating dialysis therapy are based on level of kidney function and clinical evidence of uremia. In several studies, early dialysis showed no benefit in mortality and complication rate. Thus we examined whether the timing of initiation of dialysis influenced mortality and complication rate with renal failure. METHODS: We retrospectively studied the clinical outcomes in 290 patients with renal failure who underwent dialysis therapy from 2001 to 2009. The early and late dialysis group defined as values more than and less than 10 mL/min/1.73 m2. The primary outcome was death from any cause and the secondary outcome was complication event. RESULTS: The survival rates and complication events were compared based on the estimated glomerular filtration rate, the survival rate in late dialysis group is better than in early dialysis group and the significant prognostic factors determined by multivariate analysis were age and residual renal function at time of initiation of dialysis. No difference in complication events were observed. Subgroup analysis in hemodialysis group shows no significant difference in survival rate. CONCLUSION: The survival rate in late dialysis group is better than in early dialysis group. And the complication rate were not different in two groups.
Dialysis ; Glomerular Filtration Rate ; Humans ; Kidney ; Kidney Failure, Chronic ; Multivariate Analysis ; Renal Dialysis ; Renal Insufficiency ; Retrospective Studies ; Survival Rate ; Uremia

Nocardia farcinia, an aerobic, gram-positive bacilli actinomycetes of the genus Nocardia, is an uncommon pathogen found in humans. The most common Nocardia infection sites are the lung, central nervous system, and skin. Even though hematogenous dissemination can occur, isolation of the organism from blood cultures is very rare. We report a case of Nocardia infection that was isolated on blood cultures. A 59-year-old male with a medical history that includes a liver transplantation 6-years prior due to hepatocellular carcinoma secondary to chronic hepatitis B, developed pneumonia and was transferred to Severance Hospital. At the time of admission, the patient's initial exam showed hypothermia, tachypnea, and hypotension. His chest radiograph showed severe pneumonia and a large abscess on left upper lobe. Under the presumptive diagnosis of bacterial pneumonia or other opportunistic infection, we started broad spectrum antibiotics. However, he developed Nocardia sepsis, rapidly deteriorated, and subsequently died.
Abscess ; Actinobacteria ; Anti-Bacterial Agents ; Carcinoma, Hepatocellular ; Central Nervous System ; Hepatitis B, Chronic ; Humans ; Hypotension ; Hypothermia ; Liver ; Liver Transplantation ; Lung ; Male ; Middle Aged ; Nocardia ; Nocardia Infections ; Opportunistic Infections ; Pneumonia ; Pneumonia, Bacterial ; Sepsis ; Shock ; Shock, Septic ; Skin ; Tachypnea ; Thorax ; Transplants

Lipoma is a common neoplasm in soft tissues. However, an intrapulmonary lipoma is a rare benign tumor. Patients with a bronchial lipoma might have a malignant potential related to their smoking history due to the case reports of lung cancer accompanied with lipoma. Endobronchial lipoma can cause irreversible parenchymal lung damage if not diagnosed and treated early. Therefore, it should initially be treated by fiberoptic bronchoscopy or surgery depending on the status of distal parenchymal lung damage. Bronchiolitis obliterans with organizing pneumonia (BOOP) is a pathological syndrome that is defined by the presence of buds of granulation tissue consisting of fibroblasts and collagen within the lumen of the distal air spaces. BOOP is caused by drug intoxication, connective tissue disease, infection, obstructive pneumonia, tumors, or an unknown etiology. We encountered a 58 year-old male patient with endobronchial lipoma, causing the collapse of the right middle and lower lobes, and BOOP due to obstructive pneumonia.
Bronchiolitis ; Bronchiolitis Obliterans ; Bronchoscopy ; Collagen ; Connective Tissue Diseases ; Cryptogenic Organizing Pneumonia ; Fibroblasts ; Granulation Tissue ; Humans ; Lipoma ; Lung ; Lung Neoplasms ; Male ; Pneumonia ; Smoke ; Smoking

PURPOSE: Emergency department visits for acute allergic reactions are common. However, relatively little is known about the characteristics of patients who visit the emergency department for such reactions. We undertook this study to evaluate the frequency, the cause, the severity, the treatment and the prognosis of patients admitted for allergic reactions to a college hospital in a city. METHODS: We studied 724 patients visiting two emergency departments of college hospitals during the years 2002-2003. Clinical symptoms involved pruritus, dyspnea, hoarseness, nausea, vomiting, abdominal pain, diarrhea, dizziness, and seizure. Physical examinations involved vital signs, urticaria, rash, local edema, angioedema, rhinitis/conjunctivitis, wheezing, stridor, cyanosis, and laryngeal edema. We divided the causative agents into drugs, insects, foods, and others. We classified the treatments of the allergic reaction as antihistamines, corticosteroids, epinephrine, oxygen, and hydration. We divided patients into mild, moderate, and severe acute hypersensitivity groups. RESULTS: In order of frequency, clinical symptoms were pruritus (88.1%), urticaria (72.4%), rash (68.9%), local edema (11.7%), etc. The causative agents were foods (53.0%), unknown origin (29.1%), insects (11.0%), and drugs (6.8%). Antihistamine, corticosteroid, epinephrine were injected in 93.4%, 89.1%, 2.3% of the patients, respectively. The mild, moderate, and severe groups were 87%, 9.8%, and 3.2% of the patients, respectively. CONCLUSION: For patients with allergic symptoms visiting to the university-affiliated teaching hospitals in a small city, foods were the major causative agent, but drugs and insects provoked more severe allergic reactions.
Abdominal Pain ; Adrenal Cortex Hormones ; Anaphylaxis ; Angioedema ; Cyanosis ; Diarrhea ; Dizziness ; Dyspnea ; Edema ; Emergencies* ; Emergency Service, Hospital* ; Epinephrine ; Exanthema ; Histamine Antagonists ; Hoarseness ; Hospitals, Teaching ; Humans ; Hypersensitivity* ; Insects ; Laryngeal Edema ; Nausea ; Oxygen ; Physical Examination ; Prognosis ; Pruritus ; Respiratory Sounds ; Seizures ; Urticaria ; Vital Signs ; Vomiting