• Clinical and Experimental Pediatrics
• /
• v.53 no.2
• /
• pp.262-266
• /
• 2010

Tumor necrosis $factor-{\alpha}$ ($TNF-{\alpha}$) is a major proinflammatory cytokine involved in the pathophysiology of juvenile rheumatoid arthritis. Etanercept is an effective inhibitor of $TNF-{\alpha}$ and has shown a beneficial effect in patients with JRA. However, the most important cause of concern related to etanercept administration is infection. We report a case of encephalitis in a JRA patient receiving long-term treatment with etanercept. The patient was a 4-year-old boy with refractory JRA, and he received etanercept subcutaneously at a dose of $0.4\;mg\;kg^{-1}\;day^{-1}$ twice a week for 14 months, along with non-steroidal anti-inflammatory drugs, methotrexate, oral steroids, and sulfasalazine. The patient presented with sudden fever, headache, vomiting, a generalized tonic seizure, and changes in mental status. We suspected a central nervous system infection, and simultaneously administered antibiotics, an antiviral agent, and steroids. After 2 days of hospitalization, his mental function returned to normal, and he showed no further seizure-like movements. Brain magnetic resonance imaging scan of the patient showed a multifocal cortical lesion on both sides of the temporoparietooccipital lobe, which indicated encephalitis. Although we were unable to identify the causative organism of encephalitis, we think that the encephalitis may be attributed to infection, and the use of etanercept may have increased the risk of severe infection. Therefore, etanercept was discontinued and the patient recovered shortly after. To the best of our knowledge, this is the first case of encephalitis in a juvenile rheumatoid arthritis patient treated with etanercept.

• Clinical and Experimental Pediatrics
• /
• v.59 no.sup1
• /
• pp.25-28
• /
• 2016

Phelan-McDermid syndrome is a rare genetic disorder caused by the terminal or interstitial deletion of the chromosome 22q13.3. Patients with this syndrome usually have global developmental delay, hypotonia, and speech delays. Several putative genes such as the SHANK3, RAB, RABL2B, and IB2 are responsible for the neurological features. This study describes the clinical features and outcomes of Korean patients with Phelan-McDermid syndrome. Two patients showing global developmental delay, hypotonia, and speech delay were diagnosed with Phelan-McDermid syndrome via chromosome analysis, fluorescent in situ hybridization, and multiplex ligation-dependent probe amplification analysis. Brain magnetic resonance imaging of Patients 1 and 2 showed delayed myelination and severe communicating hydrocephalus, respectively. Electroencephalography in patient 2 showed high amplitude spike discharges from the left frontotemporoparietal area, but neither patient developed seizures. Kidney ultrasonography of both the patients revealed multicystic kidney disease and pelviectasis, respectively. Patient 2 experienced recurrent respiratory infections, and chest computed tomography findings demonstrated laryngotracheomalacia and bronchial narrowing. He subsequently died because of heart failure after a ventriculoperitoneal shunt operation at 5 months of age. Patient 1, who is currently 20 months old, has been undergoing rehabilitation therapy. However, global developmental delay was noted, as determines using the Korean Infant and Child Development test, the Denver developmental test, and the Bayley developmental test. This report describes the clinical features, outcomes, and molecular genetic characteristics of two Korean patients with Phelan-McDermid syndrome.

• Journal of the Korea Academia-Industrial cooperation Society
• /
• v.19 no.6
• /
• pp.427-431
• /
• 2018

We report a case of a patient with necrotizing fasciitis followed by liver abscess. A 51-year-old man was admitted to our hospital with a 5-day history of fever and chills with painful swelling of the right thigh. A magnetic resonance imaging (MRI) scan showed fluid collection with numerous dark signal intensities considered as air-bubbles between the posteromedial and posterolateral groups of the right thigh, resulting in presumptive diagnosis of necrotizing fasciitis. At the time of admission, an ultrasonograph of the abdomen showed increased parenchymal echogenicity of both kidneys and no liver abscess. Ten days after fasciotomy, an abdominal computed tomography (CT) scan showed intrahepatic abscess. Sonography-guided percutaneous drainage was performed. Both cultures of pus specimens from the liver abscess and right thigh yielded Klebsiella pneumoniae (K. pneumoniae). The patient was treated with fasciotomy several times and parenteral antibiotics, after which he began to improve. After 5 weeks, liver abscess size was reduced, and after 10 weeks, liver abscess disappeared. To the best of our knowledge, this is the first case of K. pneumoniae-necrotizing fasciitis followed by liver abscess.

• Progress in Medical Physics
• /
• v.17 no.2
• /
• pp.77-82
• /
• 2006

The image display is an Important component of PACS and of medical digital imaging chain. Displayed image qualify is affected by the physical characteristics of display device, appropriate clinical settings and calibrations, and ambient lighting conditions. The performance of display systems is continuously degraded over time due to luminance deterioration and changes of clinical setting parameters. A routine QC is recommended because the performance of display systems is continuously degraded over time. Ten flat panel monochrome LCD display devices were included in the evaluation of the QC effect. The effect of QC on primary class LCD medical display devices for selected QC tests was evaluated by comparing the performances, luminance response, luminance dependencies, display resolution and display chromaticity in this study, of before and after the calibration procedures. The effects of the QC are significant to luminance response and luminance spatial dependencies test and the other side, are slight to the display resolution and display chromaticity test. A routine QC of display device is essential for the consistency of medical image display and presentation. The study of the QC effects of display devices will play an important role in practical QC procedures of display devices.

• Journal of Veterinary Clinics
• /
• v.30 no.4
• /
• pp.301-304
• /
• 2013

Otic mass removal was performed in a 19-month-old, castrated domestic shorthair cat. The patient had 1- year history of recurrent otitis externa, and then otic mass in the right ear canal was found. Under general anesthesia, 2.7 mm rigid endoscope was inserted to the right ear canal with the irrigation system. The ovoid-shaped, 4.9 mm in diameter red otic mass located in the right ear canal was removed via traction-avulsion. Then, rupture of the tympanic membrane was revealed and otic flushing was performed with sterile isotonic (0.9%) saline to remove exudates. Histologically, the removed polyp was diagnosed as granulation tissue with severe ulceration. The patient didn't reveal any remarkable abnormality after surgery, and no recurrence were found after 5 months follow up. The video otoscopy seems to offer a useful option for treatment of a feline inflammatory polyp.

• Korean Journal of Veterinary Research
• /
• v.46 no.4
• /
• pp.395-398
• /
• 2006

A 2-month-old female Shih-tzu dog was referred because of lameness, exercise intolerance, depression, elbow and stifle joint swelling. Physical examination, complete blood counts, serum-chemistry, radiography, synovial fluid analysis, antinuclear antibody test, and rheumatoid factor measurement were initiated. On radiography, soft tissue swelling of elbow and stifle joints without erosiveness were founded. The results of synovial fluid analysis revealed severe neutrophilic pleocytosis (nondegenerative), decreased viscosity, increased turbidity, positive on mucin-clot test, and negative on bacterial culture. The results of rheumatoid factor measurement and antinuclear antibody test were negative and below 1 : 40, respectively. Based on all tests, we diagnosed this case as juvenile onset type I immune-mediated polyarthritis. Azathioprine (1 mg/kg body weight, per os q 24 h, for 4 weeks) was then administered and clinical signs improved gradually. Four weeks after azathioprine administration, clinical signs were disappeared. This report describes the clinical findings, imaging characteristics, synovial fluid findings, and other laboratory results of type I immune-mediated polyarthritis and successful management with azathioprine therapy.

• Journal of The Korean Society of Inherited Metabolic disease
• /
• v.18 no.1
• /
• pp.23-29
• /
• 2018

Carbamoyl phosphate synthetase 1 deficiency (CPS1D) is a rare autosomal recessive urea cycle disorder characterized by hyperammonemia. CPS1D is caused by mutations in the CPS1 gene on chromosome 2q35. Based on the age of onset, there are two phenotypes: the neonatal type and the delayed-onset type. The severity of clinical manifestation depends on the degree of CPS1 residual enzymatic activity, and can result in hyperammonemia and neurological dysfunction. We report a case of CPS1D in a neonate who developed vomiting, decreased consciousness and hyperammonemia at 25th day after birth. She showed excellent response to treatment including hydration, ammonia-lowering drugs and a low-protein diet without hemodialysis. Her growth, development and neurological outcomes were fair at the last follow-up at 17 months of age.

• Tuberculosis and Respiratory Diseases
• /
• v.72 no.5
• /
• pp.452-456
• /
• 2012

Disseminated Mycobacterium avium complex (MAC) infection can occur in immunocompromised patients, and rarely in immunocompetent subjects. Due to the extensive distribution of the disease, clinical presentation of disseminated MAC may mimic malignancies, and thorough examinations are required in order to make accurate diagnosis. We report a case of disseminated Mycobacterium intracellulare disease in an immunocompetent patient, which involved the lung, lymph nodes, spleen, and multiple bones. F-18 fluorodeoxyglucose positron-emission tomography imaging showed multiple hypermetabolic lesions, which are suggestive of typical hematogenous metastasis. However, there was no evidence of malignancy in serial biopsies, and M. intracellulare was repeatedly cultured from respiratory specimens and bones. Herein, we should know that disseminated infection can occur in the immunocompetent subjects, and it can mimic malignancies.

• Tuberculosis and Respiratory Diseases
• /
• v.65 no.4
• /
• pp.334-338
• /
• 2008

Solitary fibrous tumors of the pleura (SFTPs) are relatively rare tumors that originate from the mesenchymal cells of the submesothelial tissue of the pleura. Patients with SFTPs are often asymptomatic, while some patients experience pleuritic chest pain, cough and/or dyspnea. We report here on a case of SFTP, and the patient presented with septic shock and respiratory failure that required mechanical ventilation. A 68-year-old woman was admitted for the evaluation of her dyspnea and generalized edema. Chest imaging studies showed an 18 cm-sized voluminous mass occupying the right thoracic cavity with anterior displacement of hilar structures and atelectasis of the right lung. Immediately after admission, she developed pneumonia and septic shock that required antibiotics and mechanical ventilation. She displayed a partial response to medical treatment, and then complete excision of the tumor was performed and the pathologic examination revealed benign SFTP. Afterward, she fully improved without evidence of recurrence until now.

• Journal of Veterinary Clinics
• /
• v.29 no.5
• /
• pp.408-411
• /
• 2012

Laparoscopic-assisted ovariohysterectomy was performed in a cat (2.7 kg) with pyometra. A 10-mm operative laparoscope was inserted into the abdomen through an umbilical port. A transabdominal suspension suture was placed to maintain the exposure of the ovarian vascular pedicle. The ovarian vascular pedicle and suspensory ligament were progressively cauterized and transected with 5-mm multifunction bipolar grasping forceps. Both ovaries and the uterus were exteriorized via 5-mm caudal port enlarged to 2 cm. The uterine body and associated arteries were ligated, transfixed, and transected under direct vision. No peri- or post-operative complications were encountered. To the authors' knowledge, this is the first report of the use of laparoscopy for the treatment of pyometra in the cat.