Prevalence of Mycoplasma pneumoniae pneumonia in preschool children has shown a recent increase and macrolideresistant Mycoplasma pneumoniae pneumonia has been reported. We investigated the clinical features of Mycoplasma pneumoniae pneumonia among children of different ages and different years for the most recent seven years. Retrospective analysis was performed on the clinical data of 735 children who were hospitalized due to Mycoplasma pneumoniae pneumonia between January 2006 and December 2012. The children were divided into three groups according to age: the A group (<3 years), B group (≥3 years and <7 years), and C group (≥7 years). In addition, the children were divided into two groups according to the year in which the disease had developed: the early period (2006 and 2007 year), and the late period (from 2010 to 2012 year). The infant group (A group) presented mainly with a shorter duration of fever and more frequent wheezing. In the late period, the interval until improvement after a macrolide was prescribed increased. Clinical features of Mycoplasma pneumoniae pneumonia differed among children of different ages, particularly between infants and school-aged children.

The Ambulatory arterial stiffness index (AASI) and abnormal dipping patterns have been suggested as a risk factor for stroke. Recent studies have reported that AASI might be confounded by dipping patterns as a prognostic marker. We conducted a retrospective analysis of the data of 869 hypertensive patients for evaluation of the association of stroke with AASI and dipping patterns. AASI was higher in patients with stroke than in patients without stroke (0.47±0.16 vs. 0.41±0.17; p=0.083) and inversely related with nocturnal systolic BP reduction (r=–0.21; p<0.001). In multiple linear regression analysis, independent predictors of AASI were 24-hour pulse pressure (β= 0.447, p<0.001) and nocturnal dipping (β=–0.178, p<0.001). The odds ratio (OR) for stroke associated with AASI was 0.86 (95% confidence interval (CI), 0.29–2.5; p=0.777) after multivariate adjustment. Higher OR was observed for non-dippers, extreme-dippers, and reverse-dippers than for dippers (OR 1.57; 95% CI 1.02–2.4, p=0.04, OR 2.71; 95% CI 1.06–6.88, p=0.037, OR 2.56; 95% CI 1.56–4.2, p<0.001, respectively). The results of this study show that dipping pattern has a stronger association with stroke than AASI in patients with hypertension.

The goal of medical education is to make a desirable physician who is needed and wanted from community. The images of this ideal physician has changed over the years. We analysed the questionnaires about a good doctor which were answered by 472 students of one university except for medical, dental, nursing and pharmaceutical students. The excellent physician was regarded as a competent doctor 251 (53.2%), a doctor who is good at explanation 154 (32.6%), and a kind doctor 65 (13.8%) and etc. The mean reliability score for physician was 3.4 and for medical services 3.3, by 5-point Likert scale. The survey subjects thought that medical education to make a good physician should include communication skills (27%), medical skills (26%), medical knowledge (19%), courtesy (11%) & etc.

The procedure for spinal cord stimulation is varies according to authors. Three surgical procedures for spinal cord stimulation were reviewed. The authors reviewed seven patients who underwent spinal cord stimulation. Two patients underwent resume type stimulation electrode placement under general anesthesia. One patient underwent resume type stimulation electrode placement under local anesthesia. Four patients underwent percutaneous electrode placement under local anesthesia. Two of four patients showed good pain reduction with stimulation during the operation. Two of four patients underwent resume type stimulation electrode placement under general anesthesia. Five of seven patients underwent surgical electrode placement using a permanent system under general anesthesia. Findings of this study support that the percutaneous electrode lead is a good predictor for effectiveness of spinal cord stimulation.

After percutaneous endoscopic lumbar discectomy (PELD), postoperative radiating leg pain could persist and become a common problem. This symptom provides important information for use in deciding on performance of reoperation for remnant disc or recurrent disc herniation. Of 225 patients who underwent PELD, 51 patients had persistent radicular pain. Steroid injection to epidural space resulted in pain reduction of at least 50 % in 15 (30.3 %) of these patients. Thirty five cases showed a bad outcome after steroid injection, indicating high sensitivity for detection of a remnant or disc herniation in follow up Magnetic Resonance images (25 cases, 71.4%). Twenty one patients were treated by reoperation. Steroid injection has a diagnostic value with a high sensitivity for mechanical compression of the nerve root as remaining or recurrent disc herniation in MRI for the necessity of a re-operation.

Neutropenic enterocolitis (NE), the most serious gastrointestinal complication, has been reported as a clinical syndrome that occurs in the setting of disease- or chemotherapy-induced neutropenia. Complications of NE include bowel necrosis with perforation, fistula, stenosis, massive bleeding, abscess formation, and pneumatosis intestinalis (PI). Most physicians recommend initial conservative management with bowel rest, intravenous fluids, total parenteral nutrition, broad-spectrum antibiotics, and normalization of neutrophil counts. Surgical intervention is recommended in the event of obstruction, perforation, persistent gastrointestinal bleeding despite correction of thrombocytopenia and coagulopathy, or clinical deterioration. We experienced a patient whose abdominal computed tomography scan showed pneumoretroperitoneum, intramural gas in the colon, and inferior vena caval gas. Her condition improved after treatment with granulocyte colony-stimulating factor and broad-spectrum antibiotics. We report on this case along with a review of the literature.

Primary adenocarcinoma is a rare neoplasm of the urinary bladder, constituting approximately 2.5% of all primary bladder malignancies. Signet ring cell variant is even rarer, constituting approximately 0.5% to 2.0% of all primary carcinoma of the urinary bladder. However, glandular differentiation in the urinary bladder is relatively more common than primary adenocarcinoma of the urinary bladder. Therefore, diagnosis of primary adenocarcinoma of the urinary bladder can be very challenging, but of significant clinical importance. We report on a case of adenocarcinoma with mucinous and signet ring cell differentiation in the bladder dome in a 49-year-old female.

Spontaneous resolution of aortic dissection is extremely rare and only a few cases have reported. We report on the case of an elderly man who presented with DeBakey type III aortic dissection, which was resolved spontaneously over two years after antihypertensive treatment. We also discuss the possible mechanism and the role of conservative management.

Retroperitoneal liposarcoma is an infrequent malignancy in adulthood arising from mesenchymal tissues. It is often diagnosed when the tumor becomes too large, suppressing adjacent organs and causing symptoms. We report on a case of giant liposarcoma found in a 77-year-old female undergoing surgical resection.

Respiratory distress resulting from a neuromuscular disorder is often misdiagnosed and not managed properly until development of severe respiratory failure. Amyotrophic lateral sclerosis (ALS) is a rare but archetypical motor neuron disease. Most cases manifest as weakness, muscular atrophy, and progressive paralysis of the limbs. Late stage of the disease is characterized by respiratory failure due to respiratory muscle weakness. In a few cases, 3% of patients, respiratory failure is the initial presentation, preceding other symptoms. We report on a case of ALS accompanied by acute respiratory failure and weaning failure, with a review of the literature.

We report on a unique case of diffuse large B-cell lymphoma of the cecum, which presented as a subepithelial tumor. A 62- year-old woman with abdominal pain underwent a colonoscopy, resulting in detection of a subepithelial tumor measuring 2 cm in the cecum. We performed a right hemicolectomy with diagnostic and curative intent; histological examination and immunohistochemical staining of the resected tumor indicated a diagnosis of diffuse large B-cell lymphoma. The patient achieved complete remission with combination chemotherapy.

Cervical epidural injection is a common treatment for management of neck, shoulder, and upper extremity pain. Although several complications are possible, cardiopulmonary arrest and intraventricular pneumocephalus are rare serious complications, mainly occurring when the dura has been punctured. We report on a case of cardiopulmonary arrest and intraventricular pneumocephalus after cervical epidural injection with loss of resistance technique using air. After performance of cardiopulmonary resuscitation for 30 minutes, a pulse was regained; however, the patient’s mental status was coma. Despite receiving conservative treatment, the patient ultimately died without recovery of consciousness.

Amyloidosis is a disease caused by extracellular deposition of the fibrous protein amyloid in one or more sites of the body, leading to organ dysfunction and death. Its causes and pathogenesis are variable, with common histopathologic features. Amyloidosisis a rare disease, and usually present in the heart and frequently in the gastrointestinal tract, skin but is rarely encountered in lymph nodes. Amyloidosis in Waldenström’s macroglobulinemia (WM) is exclusively due to amyloid lightchain deposition. Only a few case of amyloidosis in WM have been reported. We report on one case that occurred independently of with Primary amyloidosis which involved only multiple lymphadenopathy and waldenstrom’s microglobulinemia involving bone marrow.

Infection is common in neutropenic patients who have hematologic malignancies. Pyomyositis forms abscesses in the skeletal muscle withStaphylococcus aureusas the most common pathogen. Patients with pyomyositis who also have hematologic malignancies are rare especially when the primary diagnosis was the malignancy. In addition, to the authors’ knowledge there are no reports of Pseudomonas species as the myositis pathogen.

Intussusception in adults is a rare disease entity; its clinical course and etiology are different from its pediatric counterpart. Furthermore, intussusception caused by intestinal tuberculosis is very rare. We report on a case of transient intussusception induced by intestinal tuberculosis. A 29-year-old female visited our hospital with a chief complaint of right lower quadrant abdominal pain. Abdominal computed tomography showed ileo-colic type intussusception. Intussusception was transient and showed spontaneous reduction. Colonoscopy was performed for evaluation of the cause and intestinal tuberculosis was probable on colonoscopic biopsy. Follow up colonoscopy showed improvement after administration of anti-tuberculosis medication and intestinal tuberculosis was then confirmed.

Behcet’s disease (BD) is characterized by oral or orogenital ulcers and various systemic symptoms. Ankylosing spondylitis (AS), a prototype of the seronegative spondiloarthropathy(SNSpA) group, is a chronic inflammatory disease of the axial skeleton primarily involving the sacroiliac joint and vertebrae. Coexistence of BD and AS has rarely been reported. We report on a patient with concomitant AS and BD who was treated successfully with etanercept. Several case reports suporting the effectiveness of other medications such as NSAIDs in patients with coexisting AS and BD have been reported in the literature. However, we found no report regarding the use of anti TNF-α agent for treatment of these patients except for one case of adalimumab. To be best of our knowledge, this is the first case of a patient with concomitant AS and BD treated with etanercept.