Epstein-Barr virus (EBV) causes a variety of central nervous system infections, including encephalitis. EBV encephalitis accounts for approximately 5.8% of all viral encephalitis, with fever, headache, convulsions, and decreased consciousness as common symptoms. Brain magnetic resonance imaging (MRI) in EBV encephalitis shows high signal intensity mainly in the parieto-occipital cortex, subcortical white matter, and deep gray matter nuclei with reversibility. In this report, we present a case of bilateral corticospinal tract involvement (wineglass sign) identified on brain MRI in a patient with diagnosed with EBV encephalitis.

Epstein-Barr virus (EBV) causes a variety of central nervous system infections, including encephalitis. EBV encephalitis accounts for approximately 5.8% of all viral encephalitis, with fever, headache, convulsions, and decreased consciousness as common symptoms. Brain magnetic resonance imaging (MRI) in EBV encephalitis shows high signal intensity mainly in the parieto-occipital cortex, subcortical white matter, and deep gray matter nuclei with reversibility. In this report, we present a case of bilateral corticospinal tract involvement (wineglass sign) identified on brain MRI in a patient with diagnosed with EBV encephalitis.

Epstein-Barr virus (EBV) causes a variety of central nervous system infections, including encephalitis. EBV encephalitis accounts for approximately 5.8% of all viral encephalitis, with fever, headache, convulsions, and decreased consciousness as common symptoms. Brain magnetic resonance imaging (MRI) in EBV encephalitis shows high signal intensity mainly in the parieto-occipital cortex, subcortical white matter, and deep gray matter nuclei with reversibility. In this report, we present a case of bilateral corticospinal tract involvement (wineglass sign) identified on brain MRI in a patient with diagnosed with EBV encephalitis.

Background: The quick sequential organ failure assessment (qSOFA) score is suggested to use for screening patients with a high risk of clinical deterioration in the general wards, which could simply be regarded as a general early warning score. However, comparison of unselected admissions to highlight the benefits of introducing qSOFA in hospitals already using Modified Early Warning Score (MEWS) remains unclear. We sought to compare qSOFA with MEWS for predicting clinical deterioration in general ward patients regardless of suspected infection. Methods: The predictive performance of qSOFA and MEWS for in-hospital cardiac arrest (IHCA) or unexpected intensive care unit (ICU) transfer was compared with the areas under the receiver operating characteristic curve (AUC) analysis using the databases of vital signs collected from consecutive hospitalized adult patients over 12 months in five participating hospitals in Korea. Results: Of 173,057 hospitalized patients included for analysis, 668 (0.39%) experienced the composite outcome. The discrimination for the composite outcome for MEWS (AUC, 0.777;95% confidence interval [CI], 0.770–0.781) was higher than that for qSOFA (AUC, 0.684;95% CI, 0.676–0.686; P < 0.001). In addition, MEWS was better for prediction of IHCA (AUC, 0.792; 95% CI, 0.781–0.795 vs. AUC, 0.640; 95% CI, 0.625–0.645; P < 0.001) and unexpected ICU transfer (AUC, 0.767; 95% CI, 0.760–0.773 vs. AUC, 0.716; 95% CI, 0.707–0.718; P < 0.001) than qSOFA. Using the MEWS at a cutoff of ≥ 5 would correctly reclassify 3.7% of patients from qSOFA score ≥ 2. Most patients met MEWS ≥ 5 criteria 13 hours before the composite outcome compared with 11 hours for qSOFA score ≥ 2. Conclusion MEWS is more accurate that qSOFA score for predicting IHCA or unexpected ICU transfer in patients outside the ICU. Our study suggests that qSOFA should not replace MEWS for identifying patients in the general wards at risk of poor outcome.

The clinical presentation of pheochromocytoma is variable. The classic symptoms are headache, diaphoresis, and tachycardia, with paroxysmal hypertension. Other less common cardiovascular manifestations, such as arrhythmias, angina pectoris, acute myocardial infarction, dilated cardiomyopathy, and acute heart failure, have been reported occasionally. We present the case of a middle-aged woman who had stress-induced cardiomyopathy with a left ventricular thrombus, due to the pheochromocytoma. The thrombus was embolized to the aorto-iliac bifurcation during hospitalization. We removed the thrombus by a catheter thromboembolectomy and performed a surgical left adrenalectomy. After the operation, all of her symptoms and the underlying diseases (hypertension, hyperglycemia, heart failure, dyslipidemia) resolved.
Adrenalectomy ; Angina Pectoris ; Arrhythmias, Cardiac ; Cardiomyopathies* ; Cardiomyopathy, Dilated ; Catheters ; Female ; Headache ; Heart Failure ; Hospitalization ; Humans ; Hyperglycemia ; Hypertension ; Myocardial Infarction ; Pheochromocytoma* ; Tachycardia ; Thrombosis*

BACKGROUND: A chest computed-tomography has become more prevalent so that it is more common to detect small sized pulmonary nodules that have not been found in previous simple chest x-ray. If those detected nodules are undersized or located in pulmonary parenchyma, it is difficult to accomplish a biopsy since it is vulnerable to explore them either grossly or digitally. Thus, in our hospital, a thoracoscopic pulmonary wedge resection was performed after locating a lesion by means of hook wire with CT-guided. MATERIAL AND METHOD: 31 patients (17 males and 14 female patients) from December in 2006 to June in 2010 became our subjects; their 34 pulmonary nodules were subjected to the thoracoscopic pulmonary wedge resection after locating a lesion by means of hook wire with CT-guided. Also we analyzed a possibility of hook wire dislocation, a frequency of conversion to open thoracotomy, time consumed to operation after location of a lesion, operation time, post operation complication, and histological diagnosis of the lesion. RESULT: 12 of 34 cases were ground glass lesion, whereas 22 cases of them were solitary pulmonary lesion. The median value of the lesion was 8mm in size (range: 3 to 23 mm), while the median value was 12.5 mm in depth (range: 1 to 34 mm). The median value of time consumed from location of the lesion to anesthetic induction was 86.5 minutes (41~473 minutes); furthermore the mean value of operation time was 103 minutes (25~345 minutes). Intrathoracic wire dislocation was found in one case, but a target lesion was successfully excised. Open thoracotomy was performed in four cases due to pleural adhesion. However, there was no case of conversion to open thoracotomy due to failure to detect a target lesion. In histological diagnosis, metastatic cancer were found in 15 cases, which were the most common, primary lung cancer were in 9 cases, non-specific inflammation were in 3 cases, tuberculosis inflammation were in 2 cases, lymph nodes were in 2 cases, active tuberculosis were in 1 case, atypical adenomatous hyperplasia was in 1 case and normal lung parenchymal finding was in 1 case, respectively. CONCLUSION: In our hospital, in order to accomplish a precise histological diagnosis of ground-glass lesion and pulmonary nodules in lung parenchyma, location of pulmonary nodules were exactly located with hook wire under chest computed-tomography, which was followed by lung biopsy. We concluded that this was an accurate, minimally invasive and valuable method to minimize the complications and increase of cost of medical service provided.
Biopsy ; Dislocations ; Female ; Glass ; Humans ; Hyperplasia ; Inflammation ; Lung ; Lung Neoplasms ; Lymph Nodes ; Male ; Thoracoscopy ; Thoracotomy ; Thorax ; Tuberculosis

To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.
Adult ; Aged ; *Chest Pain/diagnosis/etiology/radiography ; Coronary Angiography/*methods ; Coronary Stenosis/radiography ; Decision Making ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods

We report here on a case of obstruction of a reinforced endotracheal tube (4.5 mm) with purulent bronchial secretions during performance of myringotomy and a pharyngeal flap operation under general anesthesia. This 4 year-old child, who had had a history of upper respiratory tract infection (URI), had been referred to a pediatrician before surgery and the baby was deemed to be well without any URI symptoms. But failure to achieve ventilation along with high end-tidal carbon dioxide tension and the inability to pass the catheter tip through the endotracheal tube were noticed 30 minute after the induction of anesthesia. We exchanged the tube for a 4.5 mm RAE tube and we found the reinforced tube was completely occluded by purulent secretions. After exchange of the tube, the patient's ventilation was improved immediately, but further surgical procedures were canceled by the plastic surgeon.
Anesthesia* ; Anesthesia, General ; Carbon Dioxide ; Catheters ; Child* ; Child, Preschool ; Humans ; Intubation ; Mucus* ; Pediatrics ; Respiratory System* ; Respiratory Tract Infections* ; Ventilation

PURPOSE: DNA flow cytometry is a simple and easy method to assess the DNA content and the cell-cycle distribution of a tumor cell. The prognostic significance of the DNA content and the S-phase fraction in a gastric carcinoma has been controversial. The purpose of this study was to evaluate the prognostic significance of the nuclear DNA content and the S-phase fraction in patients with a gastric carcinoma. METHODS: Between May 1995 and March 1996, 94 patients who were underwent a gastric resection for a gastric carcinoma were evaluated with DNA flow cytometry. Of them, 88 patients underwent a gastric resection with curative intent. The relationship of variable clinicopathological factors and of recurrence pattern to survival and nuclear DNA content were assessed. RESULTS: The mean age was 55 years. 55 patients (58.5%) exbitied diploidy and 39 patients (41.5%) aneuploidy. There was no relationship between the clinicopathological factors and either the ploidy pattern or the S-phase fraction. Though the recurrence and its pattern were not different between the two ploidy group (p=0.860, 0.137), diploidy tended to recur locoregionally and aneuploidy hematogenously. CONCLUSION: The ploidy pattern was a significant prognostic factor in gastric carcinomas, but should be interpreted carefully.
Aneuploidy ; Diploidy ; DNA* ; Flow Cytometry ; Humans ; Ploidies ; Prognosis ; Recurrence