Actinomycosis is rarely accompanied by fungus balls. It is difficult to distinguish between actinomycosis and a fungus ball due to their similar clinical and computed tomography scan results. Thus, a meticulous histopathological examination is required for definite diagnosis. We report a case of actinomycosis accompanied by a fungus ball, found incidentally in a patient without rhinologic symptoms. The patient was successfully treated with endoscopic sinus surgery, followed by short-term antibiotic therapy. We suggest that shortterm antibiotic therapy may be more appropriate than long-term antibiotic therapy based on our case study as well as several other studies.

Eosinophilic meningitis is defined as the presence of more than 10 eosinophils per μl in the cerebrospinal fluid (CSF), or eosinophils accounting for more than 10% of CSF leukocytes in patients with acute meningitis. Parasites are the most common cause of eosinophilic meningitis worldwide, but there is limited research on patients in Korea. Patients diagnosed with eosinophilic meningitis between January 2004 and June 2018 at a tertiary hospital in Seoul, Korea were retrospectively reviewed. The etiology and clinical characteristics of each patient were identified. Of the 22 patients included in the study, 11 (50%) had parasitic causes, of whom 8 (36%) were diagnosed as neurocysticercosis and 3 (14%) as Toxocara meningitis. Four (18%) patients were diagnosed with fungal meningitis, and underlying immunodeficiency was found in 2 of these patients. The etiology of another 4 (18%) patients was suspected to be tuberculosis, which is endemic in Korea. Viral and bacterial meningitis were relatively rare causes of eosinophilic meningitis, accounting for 2 (9%) and 1 (5%) patients, respectively. One patient with neurocysticercosis and 1 patient with fungal meningitis died, and 5 (23%) had neurologic sequelae. Parasite infections, especially neurocysticercosis and toxocariasis, were the most common cause of eosinophilic meningitis in Korean patients. Fungal meningitis, while relatively rare, is often aggressive and must be considered when searching for the cause of eosinophilic meningitis.

Multisystem inflammatory disease in children is a Kawasaki disease like illness occurring after severe acute respiratory syndrome coronavirus 2 infection in children. As the pandemic progresses, similar syndromes were also reported in adult with a decreased incidence.Multisystem inflammatory syndrome in adults (MIS-A) can be characterized with shock, heart failure, and gastrointestinal symptoms with elevated inflammatory markers after coronavirus disease 2019 (COVID-19) infection. Herein, we describe the first case of MIS-A in South Korea. A 38-year-old man presented to our hospital with a 5-day history of abdominal pain and fever. He had been treated with antibiotics for 5 days at the previous hospital, but symptoms had worsened and he had developed orthopnea on the day of presentation.He suffered COVID-19 six weeks ago. Laboratory data revealed elevated white blood cell counts with neutrophil dominance, C-reactive protein, and B-type natriuretic peptide. Chest X-ray showed normal lung parenchyme and echocardiography showed severe biventricular failure with normal chamber size. We diagnosed him as MIS-A and treated with intravenous immunoglobulin and steroid.

Eosinophilic meningitis is defined as the presence of more than 10 eosinophils per μl in the cerebrospinal fluid (CSF), or eosinophils accounting for more than 10% of CSF leukocytes in patients with acute meningitis. Parasites are the most common cause of eosinophilic meningitis worldwide, but there is limited research on patients in Korea. Patients diagnosed with eosinophilic meningitis between January 2004 and June 2018 at a tertiary hospital in Seoul, Korea were retrospectively reviewed. The etiology and clinical characteristics of each patient were identified. Of the 22 patients included in the study, 11 (50%) had parasitic causes, of whom 8 (36%) were diagnosed as neurocysticercosis and 3 (14%) as Toxocara meningitis. Four (18%) patients were diagnosed with fungal meningitis, and underlying immunodeficiency was found in 2 of these patients. The etiology of another 4 (18%) patients was suspected to be tuberculosis, which is endemic in Korea. Viral and bacterial meningitis were relatively rare causes of eosinophilic meningitis, accounting for 2 (9%) and 1 (5%) patients, respectively. One patient with neurocysticercosis and 1 patient with fungal meningitis died, and 5 (23%) had neurologic sequelae. Parasite infections, especially neurocysticercosis and toxocariasis, were the most common cause of eosinophilic meningitis in Korean patients. Fungal meningitis, while relatively rare, is often aggressive and must be considered when searching for the cause of eosinophilic meningitis.

Multisystem inflammatory disease in children is a Kawasaki disease like illness occurring after severe acute respiratory syndrome coronavirus 2 infection in children. As the pandemic progresses, similar syndromes were also reported in adult with a decreased incidence.Multisystem inflammatory syndrome in adults (MIS-A) can be characterized with shock, heart failure, and gastrointestinal symptoms with elevated inflammatory markers after coronavirus disease 2019 (COVID-19) infection. Herein, we describe the first case of MIS-A in South Korea. A 38-year-old man presented to our hospital with a 5-day history of abdominal pain and fever. He had been treated with antibiotics for 5 days at the previous hospital, but symptoms had worsened and he had developed orthopnea on the day of presentation.He suffered COVID-19 six weeks ago. Laboratory data revealed elevated white blood cell counts with neutrophil dominance, C-reactive protein, and B-type natriuretic peptide. Chest X-ray showed normal lung parenchyme and echocardiography showed severe biventricular failure with normal chamber size. We diagnosed him as MIS-A and treated with intravenous immunoglobulin and steroid.

Purpose: To compare image quality in selective intracoronary contrast-injected computed tomography angiography (SelectiveCTA) with that in conventional intravenous contrast-injected CTA (IV-CTA). Materials and Methods: Six pigs (35 to 40 kg) underwent both IV-CTA using an intravenous injection (60 mL) and Selective-CTA using an intracoronary injection (20 mL) through a guide-wire during/after percutaneous coronary intervention. Images of the common coronary artery were acquired. Scans were performed using a combined machine comprising an invasive coronary angiography suite and a 320-channel multi-slice CT scanner. Quantitative image quality parameters of CT attenuation, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), mean lumen diameter (MLD), and mean lumen area (MLA) were measured and compared. Qualitative analysis was performed using intraclass correlation coefficient (ICC), which was calculated for analysis of interobserver agreement. Results: Quantitative image quality, determined by assessing the uniformity of CT attenuation (399.06 vs. 330.21, p<0.001), image noise (24.93 vs. 18.43, p<0.001), SNR (16.43 vs. 18.52, p=0.005), and CNR (11.56 vs. 13.46, p=0.002), differed significantly between IV-CTA and Selective-CTA. MLD and MLA showed no significant difference overall (2.38 vs. 2.44, p=0.068, 4.72 vs. 4.95, p=0.078).The density of contrast agent was significantly lower for selective-CTA (13.13 mg/mL) than for IV-CTA (400 mg/mL). Agreement between observers was acceptable (ICC=0.79±0.08). Conclusion Our feasibility study in swine showed that compared to IV-CTA, Selective-CTA provides better image quality and requires less iodine contrast medium.

Angiography ; Bias (Epidemiology) ; Constriction, Pathologic ; Coronary Angiography ; Fractional Flow Reserve, Myocardial ; Humans ; Ischemia ; Patient-Specific Modeling ; Sensitivity and Specificity

BACKGROUND AND OBJECTIVES: Auditory brainstem response (ABR) can be utilized to verify the hearing threshold and determine the existence of retrocochlear pathology in sudden deafness. However, little is known about the significance of ABR characteristics as a prognostic factor in sudden deafness. The purpose of this study is to evaluate which characteristics of ABR is associated with the prognosis of sudden deafness. SUBJECTS AND METHOD: We studied patients who were diagnosed with unilateral sudden deafness from January 2017 to May 2018. ABR results of click stimuli at 90 dB nHL were analyzed by the latency of wave I, III, and V. RESULTS: A total of 113 patients (55 men and 58 women) participated in the study. Hearing recovery was observed in 94 cases (83.2%). The absolute latency of wave I, III, and V was prolonged in the affected ears when compared with the unaffected ears. Hearing improvement was only correlated to the interaural latency delay of wave I (Pearson's r=−0.278, p<0.05). Prolonged interaural latency delay was noted from complete toward slight hearing recovery group. When the hearing outcome was evaluated by the interaural latency delay of wave I at 0.2 ms, the result of under 0.2 ms was significantly better than that over 0.2 ms and no visible wave I. CONCLUSION: Prolonged interaural delay of wave I over 0.2 ms and no visible wave I in ABR showed worse hearing outcome in sudden deafness. This finding may provide ABR as a potential prognostic indicator in sudden deafness.
Ear ; Evoked Potentials ; Evoked Potentials, Auditory, Brain Stem ; Hearing Loss, Sudden ; Hearing ; Humans ; Male ; Methods ; Pathology ; Prognosis

BACKGROUND AND OBJECTIVES: Auditory brainstem response (ABR) can be utilized to verify the hearing threshold and determine the existence of retrocochlear pathology in sudden deafness. However, little is known about the significance of ABR characteristics as a prognostic factor in sudden deafness. The purpose of this study is to evaluate which characteristics of ABR is associated with the prognosis of sudden deafness.SUBJECTS AND METHOD: We studied patients who were diagnosed with unilateral sudden deafness from January 2017 to May 2018. ABR results of click stimuli at 90 dB nHL were analyzed by the latency of wave I, III, and V. RESULTS: A total of 113 patients (55 men and 58 women) participated in the study. Hearing recovery was observed in 94 cases (83.2%). The absolute latency of wave I, III, and V was prolonged in the affected ears when compared with the unaffected ears. Hearing improvement was only correlated to the interaural latency delay of wave I (Pearson's r=−0.278, p<0.05). Prolonged interaural latency delay was noted from complete toward slight hearing recovery group. When the hearing outcome was evaluated by the interaural latency delay of wave I at 0.2 ms, the result of under 0.2 ms was significantly better than that over 0.2 ms and no visible wave I. CONCLUSION Prolonged interaural delay of wave I over 0.2 ms and no visible wave I in ABR showed worse hearing outcome in sudden deafness. This finding may provide ABR as a potential prognostic indicator in sudden deafness.

BACKGROUND: Preoperative pain in the symptomatic knee may predict postoperative pain severity in patients undergoing total knee arthroplasty (TKA). However, the effect of preoperative pain external to the knee on postoperative pain is unclear. This study evaluated postoperative pain outcomes in TKA patients according to the presence of preoperative pain in the knee only or in the knee and external to the knee.METHODS: We retrospectively assessed medical records of patients who underwent unilateral TKA. The relationship between reported preoperative pain characteristics and morphine equivalent consumption or numerical rating scale (NRS) pain scores on postoperative day (POD) 0–3 was assessed using a multivariable generalized linear model.RESULTS: In total, 3,429 adult patients who underwent their first TKA were included; 2,864 (83.5%) patients preoperatively experienced only knee pain and 565 (16.5%) knee pain with external to knee pain. Preoperative pain in the knee and external to the knee was associated with 5% higher morphine equivalent consumption on POD 0–3 compared to preoperative knee pain only (exponentiated regression coefficient: 1.05; 95% confidence interval: 1.02 to 1.09; P = 0.004). However, the NRS pain scores on POD 0, 1, 2, and 3 and adjuvant analgesics consumption (acetaminophen and ketorolac) on POD 0–3 were not significantly different between the two groups (P > 0.05).CONCLUSIONS: This study showed that there was an increase of morphine equivalent consumption during POD 0–3 in patients with preoperative knee pain with external to knee pain than in patients with preoperative only knee pain.
Adult ; Analgesics ; Analgesics, Opioid ; Arthralgia ; Arthroplasty, Replacement, Knee ; Humans ; Knee ; Linear Models ; Medical Records ; Morphine ; Pain, Postoperative ; Retrospective Studies