Internal medicine
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Case Reports
A case of osteoarthropathy due to Erdheim-Chester disease with overlapping Langerhans' cell infiltration.
Histiocytosis sometimes involves the joints, and is one of the important differential diagnoses of osteoarthropathy. A 31-year-old man presented with recurrent fever and bilateral knee arthritis two years prior to admission. ⋯ Histological findings of bone biopsy revealed foamy macrophage infiltration, which were CD68+CD1a-S100-, and Erdheim-Chester disease was diagnosed. In addition, CD68+CD1a+ Langerhans' cells also aggregated in the same lesions, and we thought this case was a rare variant of Erdheim-Chester disease with overlapping histiocytic invasion.
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With conventional MRI and single-photon emission computed tomography (SPECT), accurate diagnosis and precise classification of cerebellar atrophy are often difficult. The objective was to verify the utility of MRI voxel-based morphometry (VBM) in combination with SPECT using easy Z-score imaging (eZIS) for diagnosing and classifying cerebellar atrophy. ⋯ VBM clearly showed characteristic gray matter atrophy in the cerebellum and brainstem in different pathological conditions, thus indicating its high degree of utility in diagnosing and classifying cerebellar atrophy in combination with SPECT using eZIS.
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Our study was undertaken to determine the location of the tortuous intercostal artery in elderly patients by using 3D-CT angiography in order to prevent laceration during thoracentesis. ⋯ We showed that the intercostal artery is tortuous and does not always lie along the inferior edge of the rib and that the percent safe space at the lateral site is significantly higher than that at the medial site in elderly patients.
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In this 71-year-old man diagnosed as obstructive sleep apnea syndrome initially, the apnea-hypopnea index in polysomnography was 31.3/hour. He started auto-adjusted continuous positive airway pressure (auto-CPAP) treatment in July 2005 but developed congestive heart failure in December 2007. ⋯ After replacing auto-CPAP with adaptive servo-ventilation (ASV), the apnea-hypopnea index was 5.3/hour and PAP became 36 mmHg after 3 months. It was thought that the increase of PAP was due to long-term inadequate use of auto-CPAP.
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Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are usually life threatening, but the recent trend of 28-day case-fatality and associated risk factors including Charlson index have not been known. Our aim was to evaluate the 28-day case-fatality rate among hospitalized DKA and HHS patients in a teaching hospital in Taiwan from 1991 to 2005. ⋯ Improvements in case-fatality in recent years for both DKA and HHS were found in the study hospital. Further reduction of the case-fatality rate among DKA and HHS patients can be achieved by optimal management of certain co-morbidities.