Two Whooper swan (Cygnus cygnus) died after suffering from pododermatitis, lethargy, and ataxia; necropsy was performed. Grossly, the liver was swollen and firm. The kidney and spleen were also enlarged and a pale tan color. On histopathologic examination with Congo red staining, amyloidosis was noted in liver, spleen, and kidney. In addition, marked osseous metaplasia was present in the liver. Based on these results, systemic amyloidosis involving liver, spleen, and kidney with osseous metaplasia in the liver was diagnosed. Study results indicate that an inflammatory reaction associated with pododermatitis had a role in the amyloidosis in this particular case.
Amyloidosis* ; Ataxia ; Congo Red ; Kidney ; Lethargy ; Liver ; Metaplasia ; Spleen ; Triacetoneamine-N-Oxyl

Sarcoidosis is a systemic disease of unknown etiology that may affect any organ in the body. The nervous system is involved in 5-16% of cases of sarcoidosis. Here, we report a case of intramedullary sarcoidosis presenting with delayed spinal cord swelling after laminoplasty for the treatment of compressive cervical myelopathy. A 56-year-old woman was admitted to our hospital complaining of upper extremity pain and gait disturbance. The patient had undergone laminoplasty for compressive cervical myelopathy 3 months previously. Follow-up magnetic resonance imaging revealed a large solitary intramedullary lesion with associated extensive cord swelling, signal changes, and heterogeneous enhancement of spinal cord from C2 to C7. Spinal cord biopsy revealed non-necrotizing granulomas with signs of chronic inflammation. The final diagnosis of sarcoidosis was based upon laboratory data, imaging findings, histological findings, and the exclusion of other diagnoses. Awareness of such presentations and a high degree of suspicion of sarcoidosis may help arrive at the correct diagnosis.
Biopsy ; Diagnosis ; Female ; Follow-Up Studies ; Gait ; Granuloma ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Middle Aged ; Nervous System ; Sarcoidosis* ; Spinal Cord Diseases* ; Spinal Cord* ; Upper Extremity

Meralgia paresthetica (MP), first described in 1878, is a sensory mononeuropathy of the lateral femoral cutaneous nerve (LFCN) characterized by pain, tingling, numbness, and paresthesias localized to the anterolateral thigh. There are many etiologies for MP, including those that are spontaneous (idiopathic, metabolic or mechanical) and iatrogenic (surgery, trauma). A 46-year-old female came to our emergency department (ED) with a right hip pain that developed after two days of an altered mental status from high amounts of multiple drugs (benzodiazepine, SSRI, and antipsychotics) to commit suicide. Her past medical and surgical histories were unremarkable. In addition, her vital signs were stable and her electrocardiography was unremarkable. On the other hand, laboratory tests showed an elevated creatinine kinase 14787 IU/L (normal range, 26~140 IU/L) and urine myoglobin >1000 ng/mL (normal range, 0~10 ng/mL). She was admitted to our ED for the management of rhabdomyolysis. The patient didn't slip down and slept on her right side for a long period. An initial pelvis and femur x-ray ruled out a fracture and a straight leg raise test was negative. We took a lumbar spine x-ray to rule out a herniated intervertebral disk because she complained of pain in the second and third lumbar distribution of her right thigh. These x-rays were unremarkable. We presumed she had a hip and thigh contusion and gave her painkillers, but her symptoms did not improved. After a day, the patient complained of numbness (5/10) rather than pain. We then suspected peripheral neuropathy. Her electromyography and nerve conduction velocity confirmed right LFCN neuropathy, MP. MP is often clinically diagnosed and treated conservatively. It is a neurologic disorder due to the entrapment of the LFCN. This case shows that a long period lacking in movement can cause MP. In future cases, the possibility of peripheral neuropathy should be considered, especially in mentally altered patients after drug intoxication.
Contusions ; Creatinine ; Electrocardiography ; Electromyography ; Emergencies ; Female ; Femur ; Hand ; Hip ; Humans ; Hypesthesia ; Intervertebral Disc ; Leg ; Mononeuropathies ; Myoglobin ; Nerve Compression Syndromes ; Nervous System Diseases ; Neural Conduction ; Paresthesia ; Pelvis ; Peripheral Nervous System Diseases ; Phosphotransferases ; Porphyrins ; Spine ; Suicide ; Thigh ; Vital Signs

PURPOSE: In 2000, the American Heart Association and International Liaison Committee on Resuscitation published guidelines for CPR (Cardiopulmonary Resuscitation), and these guidelines were revised in 2005. Many physicians perform CPR differently than suggested by these guidelines. We investigated guideline conformation rates for CPR by non-emergency physicians. METHODS: From January 1st, 2005, to December 31st, 2005, and from January 1st, 2007, to September 30th, 2007, 103 in-hospital CPR cases were enrolled. We separated the 103 cases into two groups: 2005 patients and 2007 patients. Fifty-two cases in the 2005 group and 51 cases in the 2007 group were enrolled. The defibrillation method, defibrillation energy, epinephrine use, and atropine use were analyzed. RESULTS: Nineteen cases (82.6%) in the 2005 group and three cases (21.4%) in the 2007 group were performed using the appropriate defibrillation method (p=0.0002). Seventeen cases (73.9%) in the 2005 group and four cases (28.6%) in the 2007 group received the appropriate defibrillation energy (p=0.0069). Seven cases (14.0%) in the 2005 group and 16 cases (32.0%) in the 2007 group used the appropriate epinephrine dose (p=0.0325). Fourteen cases (28.0%) in the 2005 patient group and 14 cases (29.2%) in the 2007 patient group used the appropriate atropine dose (p=0.8983). CONCLUSION: Although CPR guidelines were renewed in 2005, many physicians do not follow these guidelines. We suggest that adequate information, education, feedback, and further study are needed for guideline conformation.
American Heart Association ; Atropine ; Cardiopulmonary Resuscitation ; Electric Countershock ; Epinephrine ; Humans ; Resuscitation

Anaphylaxis is one of major causes of morbidity and mortality during anesthesia. Muscle relaxants are the most common cause of anaphylaxis during anesthesia. A 54-year-old woman was scheduled for thyroidectomy. She had no history of allergy and had never previously undergone general anesthesia, Lidocaine, propofol and vecuronium were injected sequentially to induce general anesthesia. Two minutes after the vecuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The patient recovered without any significant complications after immediate proper intensive care. The operation was delayed and a skin test was performed on the 7th day after discharge. She revealed a positive skin test for vecuronium. The anesthesia was re-induced without muscle relaxant and maintained with propofol and remifentanil infusion. Surgery was completed uneventfully, and the patient recovered without any adverse reaction.
Anaphylaxis ; Anesthesia ; Anesthesia, General ; Bronchial Spasm ; Exanthema ; Female ; Humans ; Hypersensitivity ; Hypotension ; Critical Care ; Lidocaine ; Middle Aged ; Muscles ; Piperidines ; Propofol ; Skin Tests ; Tachycardia ; Thyroidectomy ; Vecuronium Bromide

Anaphylaxis is one of major causes of morbidity and mortality during anesthesia. Muscle relaxants are the most common cause of anaphylaxis during anesthesia. A 54-year-old woman was scheduled for thyroidectomy. She had no history of allergy and had never previously undergone general anesthesia, Lidocaine, propofol and vecuronium were injected sequentially to induce general anesthesia. Two minutes after the vecuronium injection, severe hypotension, tachycardia and bronchospasm developed, and delayed skin rashes appeared. The patient recovered without any significant complications after immediate proper intensive care. The operation was delayed and a skin test was performed on the 7th day after discharge. She revealed a positive skin test for vecuronium. The anesthesia was re-induced without muscle relaxant and maintained with propofol and remifentanil infusion. Surgery was completed uneventfully, and the patient recovered without any adverse reaction.
Anaphylaxis ; Anesthesia ; Anesthesia, General ; Bronchial Spasm ; Exanthema ; Female ; Humans ; Hypersensitivity ; Hypotension ; Critical Care ; Lidocaine ; Middle Aged ; Muscles ; Piperidines ; Propofol ; Skin Tests ; Tachycardia ; Thyroidectomy ; Vecuronium Bromide

BACKGROUND/AIMS: Capsule endoscopy (CE) has become a valuable modality for the detection of small bowel lesions. The usefulness of CE for obscure gastrointestinal (GI) bleeding has been established with an overall diagnostic yield of 60%. It is unknown whether CE is of equal value in all the patients or of greater benefit in selected groups in Korea. We evaluated the factors that affect the diagnostic yields of CE in patients with obscure GI bleeding. METHODS: CE was performed in 126 consecutive patients [74 men and 52 women mean age : 52.5 years (25-75 yrs), 23 with active bleeding] with obscure GI bleeding between September 2002 and July 2004. Patients were divided into two groups: those with documented bleeding lesions and those with non specific CE findings. We analyzed the clinical characteristics and other parameters that influenced the diagnostic yields of CE. RESULTS: A definite or probable cause for obscure GI bleeding was found in 69% (80/116) of the patients. NSAID induced ulcer (16.4%) and angiodysplasia (12.1%) were the most common diagnoses. In patients with active bleeding, the diagnostic yield was significantly greater than that of the patients with occult bleeding (80% vs. 68.3%, p<0.05). However, there was no significant difference in parameters between patients with abnormal CE and those with normal CE in respect to gender, age, previous bleeding history, need for transfusion, cecum imaging, and bowel preparation. CONCLUSIONS: The diagnostic yield of CE in patients with obscure GI bleeding is 69%. It is significantly higher in patients with active bleeding.
Adult ; Aged ; *Capsule Endoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnosis/etiology ; Humans ; Intestinal Diseases/*diagnosis ; Male ; Middle Aged ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity

BACKGROUND: Autologous peripheral hematopoietic stem cell transplantation (APBSCT) has been widely used to treat various types of hematological disorders, metabolic diseases and congenital immunodeficiency. Hematopoietic recovery is important because prolonged duration of neutropenia and thrombocytopenia is associated with a higher risk of infection, bleeding and treatment related mortality. Many investigators have studied the factors that affect hematopoietic recovery after stem cell transplantation. METHODS: We retrospectively investigated the factors influencing hematopoietic engraftment in 112 patients with hematological malignancies and solid tumors who received APBSCT. We evaluated the gender, age, CD34+ cell number, conditioning regimens, and the type of tumor and their association with neutrophil and platelet engraftment. RESULTS: Post-transplant neutrophil engraftment (>500/microL) required a median of 11 days (range 6~50) and platelet engraftment 12 (range 1~78) days (>20,000/microL). The univariate analysis showed that the factors that positively affected hematopoietic recovery were: the type of conditioning regimens such as BEAM (BCNU, etoposide, cytosine arabinoside, melphalan) and BEAC (BCNU, etoposide, cytosine arabinoside, cyclophosphamide) versus BC (busulfan, cyclophosphamide), the CD34+ cell number and the disease diagnosis such as multiple myeloma versus acute myelogenous leukemia. The multivariate analysis showed only the CD34+ cell number (5~10 x 10(6)/kg) to be significantly associated with early neutrophil and platelet engraftment (P<.001). CONCLUSION: These findings suggest that measurement of the CD34+ cell count may be sufficient to predict the time to engraftment after APBSCT.
Blood Platelets ; Cell Count ; Cytarabine ; Diagnosis ; Etoposide ; Hematologic Neoplasms ; Hematopoietic Stem Cell Transplantation* ; Hematopoietic Stem Cells* ; Hemorrhage ; Humans ; Leukemia, Myeloid, Acute ; Metabolic Diseases ; Mortality ; Multiple Myeloma ; Multivariate Analysis ; Neutropenia ; Neutrophils ; Research Personnel ; Retrospective Studies ; Stem Cell Transplantation ; Thrombocytopenia

Cervical incompetence is one of the main contributors to repeated pregnancy loss and preterm delivery. Typically it results in progressive cervical dilatation, leading to a painless second or early third trimester abortion. Emergency cerclage can be used in the setting of advanced cervical incompetence, even when fetal membranes bulge through the dilated cervix. To facilitate the procedure, various techniques have been developed to replace the fetal membranes into the uterine cavity. We performed six successful cases of emergency cerclage combined with amnioreduction in advanced incompetent internal os of cervix (IIOC). Interval from emergency cerclage to delivery was 8.1 +/- 2.4 weeks (range 4-10 weeks) and we delivered viable fetuses in all but one. Hereby we report our experiences with a brief review of literature.
Cervix Uteri ; Emergencies* ; Extraembryonic Membranes ; Female ; Fetus ; Humans ; Labor Stage, First ; Pregnancy ; Pregnancy Trimester, Third

Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric or gynecologic procedures. Abdominal wall endometriosis secondary to cesarean section is a very rare condition, being reported in less than 0.5% of patients undergoing cesarean section. It has a distinct presentation and treatment. An abdominal mass with noncyclical symptoms is a common presentation. Imaging techniques are nonspecific and needle biopsy may confirm the diagnosis. Wide excision is the treatment of choice for abdominal wall endometriosis as well as for recurrent lesions. A patient with a history of cesarean section presented with a painful, enlarging mass. The pain was cyclic and aggravated just prior to menstruation. The patient was treated with surgical scar excision pathologically confirmed as endometriosis. We present this case with a brief review of literature.
Abdominal Wall ; Biopsy, Needle ; Cesarean Section ; Cicatrix* ; Diagnosis ; Endometriosis* ; Female ; Humans ; Menstruation ; Pregnancy