Secondary aneurysmal bone cysts (ABCs) associated with Langerhans cell histiocytosis are rare. Although cases of ABCs arising from Langerhans cell histiocytosis in the skull have been reported in several studies, to the best of our knowledge, only two femur cases have been reported. In this case study, we described a 9-year-old boy with Langerhans cell histiocytosis of the femur. Magnetic resonance findings indicated internal multilocular cysts and multiple fluid–fluid levels, which are typical of ABCs. ABCs rarely occur in conjunction with Langerhans cell histiocytosis. Our findings may be helpful in the differential radiological diagnosis of pediatric bone tumors.

Spinal meningiomas in the epidural location are rare, accounting only 2.5% to 3.5% of all spinal meningiomas. The diagnosis of spinal epidural meningiomas, solely based on imaging findings, can be difficult. They are easily mistaken for metastatic tumors or lymphomas, especially, meningiomas of the enplaque type. Misdiagnosis of meningiomas can affect the extent of surgery and patients' outcome; hence, a careful diagnosis is needed. We report a case of pathologically confirmed epidural enplaque meningioma in the cervical spine with neural foraminal extension. Additionally, its clinical implications, radiologic features, and diagnostic difficulties are discussed.

Postoperative maxillary cyst (POMC) is relatively common complication among patients who underwent Caldwell-Luc surgery. Patients with POMC usually have no symptoms, although cyst extension can result in bone destruction or cystic infection with pain. The trigeminal nerve consists of the ophthalmic nerve, maxillary nerve, and mandibular nerve. Among these branches, the maxillary nerve runs to the lateral and frontal sides of the maxillary sinus wall. POMC can rarely lead to trigeminal neuropathy caused by cyst enlargement that compresses some branches of the trigeminal nerve. Recently, we experienced a case with trigeminal neuralgia due to POMC. The patient was successfully treated with inferior meatal antrostomy. We report this rare case with a literature review.
Humans ; Mandibular Nerve ; Maxillary Nerve ; Maxillary Sinus ; Ophthalmic Nerve ; Pro-Opiomelanocortin ; Trigeminal Nerve ; Trigeminal Nerve Diseases ; Trigeminal Neuralgia*

BACKGROUND AND OBJECTIVES: This study reviewed our experience and outcomes of surgery via transcrusal approach to the skull base lesions. SUBJECTS AND METHOD: We performed transcrusal approach technique on five patients with skull base lesions (Cavernous malformation, Petroclival meningioma, Craniopharyngioma, Anaplastic astrocytoma, and Trigerminal epidermoid cyst) aiming at preserving hearing. Pre-and post-operative pure tone audiometry (PTA) and caloric test were performed in all patients. The transcrusal approach technique was performed as reported in the previous references. The approach included trephination of the superior and posterior semicircular canals from the ampullae to the common crus. The main outcome of this study was preserving hearing and the vestibular function after surgery, which was determined by PTA and caloric test. RESULTS: The average diameter of skull base lesion of the five patients was 3.68 cm. The mean follow up period was 114.2 days. The pre-operative mean PTA of five patients was 11 dB. The mean PTA of five patients within seven days after surgery was 28 dB. The last measured mean PTA was 29.8 dB. The pre and post-operative caloric results measured revealed vestibular function deficit in all of the patients after surgery (mean decreased value: 64%). All patients were stable during the surgery. Complications included two cerebrospinal fluid leak (40%) and one cranial VI nerve deficit (20%). CONCLUSION: Transcrusal approach is a method that can simultaneously preserve hearing and afford enough exposure of the skull base lesion if appropriately combined with other transcranial approach. We performed transcrusal approach targeting skull base lesion with hearing preservation, and we found excellent hearing result with this technique.
Astrocytoma ; Audiometry ; Caloric Tests ; Cerebrospinal Fluid Leak ; Craniopharyngioma ; Follow-Up Studies ; Hearing* ; Humans ; Meningioma ; Methods ; Semicircular Canals ; Skull Base* ; Skull* ; Trephining

OBJECTIVE: Adult appendicitis (AA) with equivocal computed tomography (CT) findings remains a diagnostic challenge for physicians. Herein we evaluated the diagnostic performance of several clinical scoring systems in adult patients with suspected appendicitis and equivocal CT findings. METHODS: We retrospectively evaluated 189 adult patients with equivocal CT findings. Alvarado, Eskelinen, appendicitis inflammatory response, Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), and adult appendicitis score (AAS) scores were evaluated, receiver operating characteristic analysis was conducted, and the optimal, low, and high cut-off values were determined for patient classification into three groups: low, intermediate, or high. RESULTS: In total, 61 patients were included in the appendicitis group and 128 in the non-appendicitis group. There were no significant differences between the area under the curve of the clinical scoring systems in the final diagnosis of AA for equivocal appendicitis on CT (Alvarado, 0.698; Eskelinen, 0.710; appendicitis inflammatory response, 0.668; RIPASA, 0.653; AAS, 0.726). A RIPASA score greater than 7.5 had a high positive predictive value (90.9) and an AAS score less than or equal to 5 had a high negative predictive value (91.7) in the diagnosis of AA. CONCLUSION: The accuracy of clinical scoring systems in the diagnosis of AA with equivocal CT findings was moderate. Therefore, a high RIPASA score may assist in the diagnosis of AA in patients with equivocal CT findings, and a low AAS score may be used as a criterion for patient discharge. Most patients presented with intermediate scores. The patients with equivocal CT findings may be considered as a third diagnostic category of AA.
Adult* ; Appendicitis* ; Classification ; Clinical Decision-Making ; Diagnosis ; Diagnostic Tests, Routine ; Humans ; Multidetector Computed Tomography ; Patient Discharge ; Retrospective Studies ; ROC Curve ; Skates (Fish)

OBJECTIVE: The aim of this study was to evaluate the effect of adding bedside ultrasonography to the diagnostic algorithm for nephrolithiasis on emergency department (ED) length of stay. METHODS: A prospective, randomized, controlled pilot study was conducted from October 2014 to December 2014 with patients with acute flank pain. In the non-ultrasonography group (NUSG), non-contrast computed tomography was selected based on clinical features and hematuria in the urinalysis. In the ultrasonography group (USG), non-contrast computed tomography was selected based on clinical features and hydronephrosis on bedside ultrasonography. The primary outcome was ED length of stay. The secondary outcomes were radiation exposure, amount of analgesics, proportion of patients with diseases other than ureteral calculus, and proportion of patients with unexpected ED revisits within 7 days from the index visit. RESULTS: A total of 103 patients were enrolled (NUSG, 51; USG, 52). The ED length of stay for the USG (89.0 minutes) was significantly shorter than that for the NUSG (163.0 minutes, P<0.001). There were no significant differences between the two groups in the radiation exposure dose (5.29 and 5.08 mSv, respectively; P=0.392), amount of analgesics (P=0.341), proportion of patients with diseases other than ureteral calculus (13.0% and 6.8%, respectively; P=0.486), and proportion of patients with unexpected ED revisits within 7 days from the index visit (7.8% and 9.6%, respectively; P=1.000). CONCLUSION: The use of early bedside ultrasonography for patients with acute flank pain could reduce the ED length of stay without increasing unexpected ED revisits.
Analgesics ; Emergencies* ; Emergency Service, Hospital* ; Flank Pain ; Hematuria ; Humans ; Hydronephrosis ; Length of Stay* ; Nephrolithiasis ; Pilot Projects* ; Prospective Studies ; Radiation Exposure ; Renal Colic* ; Ultrasonography* ; Ureteral Calculi ; Ureterolithiasis ; Urinalysis

A survey was conducted to determine the perception of youku meat among college students majoring in food and/or nutrition. The survey participants were located nationwide, and the responses from the 2,454 students were analyzed. More male and higher grade students answered that they had heard about youku while only 20.0% had learned about Youku from class. Approximately 37.8% of the subjects recognized youku as 'dairy cattle which are too old to produce milk', 54.0% as 'all cattle grown for the purpose of meat', and 23.1% as 'all cattle except for Hanwoo'. Only 37.4% recognized youku correctly. Compared with the same quality grade, 25.3% recognized youku meat as being cheaper than imported beef, and only 25.6% of them recognized that youku meat has less fat than imported beef. As much as 83.3% of subjects did not know whether or not they were served youku meat, and 23.7% of subjects wanted increased availability of youku meat. As much as 22.9% of subjects opposed the increased use of youku meat, and the reasons were "it does not taste good" (18.1%), "it is not Hanwoo" (15.1%), "it is not sanitary" (13.1%), and "it is imported" (6.0%). The findings provide basic information on barriers regarding youku meat promotion among subjects who will be dieticians in food service or managers in purchase departments of catering companies in the future.
Animals ; Cattle ; Food Services ; Humans ; Male ; Meat* ; Nutritionists

Relapsing polychondritis (RP) is an uncommon systemic disease that is characterized by episodic and progressive inflammation of the cartilaginous structures, which can be very debilitating and in some instances life-threatening. The pathogenic pathways of RP are largely unknown. However, several hypothesis have been suggested. We had an interesting case of aggravation of RP due to the infection. Graft cartilage on the nasal tip was affected by RP also. This case can give a clue of revealing the pathogenesis of RP. We introduce a case with a review of the literature.
Cartilage ; Foreign-Body Reaction ; Inflammation ; Nose ; Polychondritis, Relapsing* ; Transplants*

Schwannoma is a benign tumor arising from the sheath of myelinated nerve fibers and may occur in any part of the body. However, a vidian nerve schwannoma is extremely rare. A 41 year-old man has experienced an occipital area headache and posterior neck stiffness for 2 weeks. Brain computed tomography (CT) angiography, magnetic resonance image revealed lobulated soft tissue density mass in left sphenoid sinus with upward displacement of sphenoid sinus floor and pressure erosion of sphenoid sinus and petrous apex. Ostiomeatal unit CT scan showed a 28x16 mm sized mass filling the left pterygoid canal. The mass was resected using endoscopic sinus surgery. The mass was confirmed as schwannoma. We report a case of vidian nerve schwan-noma that was treated by endoscopic sinus surgery.
Adult ; Brain ; Endoscopy ; Headache ; Humans ; Magnetic Resonance Angiography ; Neck ; Nerve Fibers, Myelinated ; Neurilemmoma* ; Sphenoid Sinus ; Tomography, X-Ray Computed

PURPOSE: Studies on the relationship between appendiceal inflammation and bedside ultrasonographic findings are lacking. The purpose of this study was to determine statistically significant parameters to diagnose appendicitis earlier by comparing ultrasonographic findings and clinical features between early and late appendicitis. METHODS: A registry of right lower quadrant (RLQ) pain ultrasound from December 2011 to December 2012 was reviewed. Among these cohorts, patients pathologically proven to have appendicitis were selected and divided into two groups: an early appendicitis group, patients who complained of a diffuse abdominal pain, and a late appendicitis group, patients who complained of a localized right lower quadrant pain. The two groups were compared according to gender, age, bedside ultrasonographic findings, inflammatory markers, clinical features, and postoperative pathological findings. RESULTS: A total of 102 patients were enrolled in this study. Among them, 42 patients (41.2%) were in the early appendicitis group and 60(58.8%) were in the late appendicitis group. Appendiceal diameter and noncompressibility did not differ between the groups. However, periappendiceal fat infiltration and fluid were less prevalent in the early group (p=0.031 vs. p=0.022, respectively). CONCLUSION: Appendiceal diameter and non-compressibility were the only bedside ultrasound findings found in early appendicitis patients. Emergency physicians can detect early appendicitis and prevent complications before the migration of abdominal pain to the RLQ by bedside ultrasonography.
Abdominal Pain ; Appendicitis* ; Biomarkers ; Cohort Studies ; Emergencies ; Humans ; Inflammation ; Ultrasonography*