Two different types, called “Yin-Yang Wu Tai” and “Yin-Yang Er Shi Wu Ren,” respectively, are described in the Huang Di Nei Jing, Ling Shu section. Each type can be divided into four closely interrelated sub-items: character, physique, constitution and therapy. These relations can be explained with the concept of the “unity of the physical and spiritual,” which is based on a holistic perspective with physical referring to the body and spiritual referring to mental activity.
If we regard these types as psychologic, we can compare them with present western psychological types. E. Kretschimer and L. Corman discussed this in relation to “character and physique” or “character and countenance.” Kampo examination of the physique and countenance are anthroposcopic. In contrast, the examination of character includes both anthroposcopy and medical interviews. Applying this knowledge, it may be possible to improve diagnostic techniques in Kampo medicine.

BACKGROUND: Acute renal failure (ARF) due to acute pyelonephritis (APN) in patients in the absence of obstructive uropathy, diabetes, or chronic renal failure was reported rarely (12 cases in the last 25 yrs in Clin Inf Dis, 1992; 243-6 by SR Jones)2). Acute renal failure is a rare complication of acute pyelonephritis in patients who do not have urinary obstruction. Although urinary tract infections are common in adults, pyelonephritis is rarely considered in the differential diagnosis of acute renal failure, and when clinicians weigh the possible consequences of bacteriuria, renal failure is not considered to be a reasonable possibility. METHODS: We observed 6 patients of acute pyelonephritis associated with acute renal failure as an initial manifestation on admission in the past 6 months. The analysis of clinical features of these 6 patients (APN+) compared to 7 patients of APN without ARF (APN-) revealed following data. RESULTS: All were female in both groups. The mean age was 331.7 years in APN+ and 48+6 years in APN-, respectively (p, ns). All in both APN- and APN+ were caused by E. coli. But, none in both groups except 1 in APN- had bacteremia. The previous history of UTI was present in 5 in APN-, but none in APN+. Duration of clinical symptoms before admission (8.4+/-0.5 vs. 4.4+/-1.0 days, P<0.05) and admission days (24.2+/-1.8 vs. 11.1+/-1.5 days, p=0.000) were significantly longer in APN+. On admission, HUN and serum creatinine was 45+/-2.7mg/dL and 3.5+/-0.2mg/dL in APN+, respectively. No one in APN+ required dialysis, and subsequently recovered renal function with prompt antibiotic therapy resulting in no significant difference compared to that of APN on discharge (serum creatinine, 1.0+/-0.1 vs. 0.9+/-0.1mg/dL). No differences in leukocytosis and serum electrolyte levels on admission were present. However, significant anemia was noted in APN+ (hemoglobin, 9.0+/-0.7 vs. 11.9+/-0.2gm/dL). The days of fever and leukocytosis before disappearance were not different in both groups, but those of flank pain (12.8+/-1.5 vs. 5.7+/-0.7 days, P=0.001) and pyuria (16+/-1.9 vs. 6.4+/-0.6 days, P=0.000) significantly longer in APN+. Upon ultrasonography, all in APN+ showed enhanced echogenicity, but I in APN . (P=P value, NS=not significant) CONCLUSION: Upon these data, we concluded that ARF associated with APN as an initial manifestation was accompanied by several distinct clinical characteristics, which could be used for the early recognition of its unusual occurrence and subsequent appropriate management including antibiotics leading to a favorable outcome.
Acute Kidney Injury* ; Adult ; Anemia ; Anti-Bacterial Agents ; Bacteremia ; Bacteriuria ; Creatinine ; Diagnosis, Differential ; Dialysis ; Female ; Fever ; Flank Pain ; Humans ; Kidney Failure, Chronic ; Leukocytosis ; Pyelonephritis* ; Pyuria ; Renal Insufficiency ; Ultrasonography ; Urinary Tract Infections

It is uncommon for Fabry's disease (FD) patient to present with an isolated ischemic stroke without other typical symptoms or signs of FD. A 48-year-old woman presented with recurrent limb weakness and her brain magnetic resonance imaging revealed multiple ischemic brain lesions. Ten years ago, the patient had been diagnosed with heterozygote FD by the genetic test, but she had not shown any typical symptoms or sign of FD so far. Isolated organ involvement could occur in heterozygote FD.
Brain ; Brain Ischemia ; Extremities ; Fabry Disease ; Female ; Heterozygote ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Stroke

A-57-year-old male patient suddenly developed cramping pain in the left lower abdomen with a slight abdominal distension. He had undergone a laparoscopic nephrectomy for transitional cell carcinoma 7 days earlier. An abdominal CT scan revealed a dilated small bowel loop and an internal hernia was suspected. Surgery revealed a herniation of the jejunal loop through defects in the retroperitoneum, which was successfully reduced. We report a case of an internal hernia following a laparoscopic nephrectomy. To the best of our knowledge, this is the only reported case of an internal hernia as a complication of laparoscopic nephrectomy.
Abdomen ; Carcinoma, Transitional Cell ; Hernia* ; Humans ; Laparoscopy ; Male ; Muscle Cramp ; Nephrectomy* ; Tomography, X-Ray Computed

PURPOSE: A solid pseudopapillary tumor (SPT) is a rare pancreatic neoplasm, with low malignant potential, which tends to occur predominantly in younger females. Most patients are diagnosed due to the abdominal pain or the large palpable abdominal mass. The treatment is surgical resection, using either enucleation or more radical procedures. Only a few cases of SPT have been reported; therefore, the purpose of this study was to evaluate the clinicopathological characteristics and prognosis after surgical resection of this rare type of tumor. METHODS: In this paper, twelve cases of SPT, treated at the Department of Surgery, Chonnam National University Hospital, between 1994 and 2003, are presented. RESULTS: 10 females, with a mean age of 32.2 years, ranging from 14 to 48, and 2 males, aged 15 and 32, were diagnosed. The tumors were large, with a mean resected diameter of 7 cm, had cystic degene rations between the solid areas, and were distributed in the head (7 cases) and the body-tail (5 cases) of the pancreas. Immunohistochemical studies were performed in 7 patients, which revealed the majority of the cases to be a-1 antitrypsin and neuron specific enolase (NSE) positive. The surgical managements of the tumors included enucleation (6 cases) or more radical procedures, such as a distal pancreatectomy (5 cases) and pancreaticoduodenectomy (1 case). There was no recurrence after the complete surgical resection. CONCLUSION: The mainstay of treatment in patient with a SPT is surgical resection, after which the prognosis was favorable.
Abdominal Pain ; Female ; Head ; Humans ; Jeollanam-do ; Male ; Pancreas* ; Pancreatectomy ; Pancreatic Neoplasms ; Pancreaticoduodenectomy ; Phosphopyruvate Hydratase ; Prognosis ; Recurrence

PURPOSE: The incidence of multiple primary malignant tumor has ranged from 0.7% to 11% in the medical literature. Various organs in the digestive system are the sites of multiple primary cancer (MPC). MPC may be synchronous or metachronous depending on the interval between their diagnosis. To the best of our knowledge, there are only rare reports of resected cases of synchronous primary carcinomas that developed in the GB and duodenum. METHODS: We present here a patient who underwent an operation for synchronous primary carcinomas of the GB and duodenum. A 51-year-old female was admitted for postprandial abdominal discomfort. CT scan and MRI of the abdomen showed a 3 x 2 cm sized heterogenously enhancing mass in the GB and a 3.7 x 2.7 cm sized hetrogenously enhancing mass in the 2nd portion of the duodeum. The laboratory findings, including the tumor markers, were non-specific. An elective operation was done under the impression of combined GB cancer and cancer in the 2nd portion of the deuodenum. On the operative findings, there was a 3 x 2.5 cm sized mass in the GB and a 5 x 4 cm sized duodenal mass with near complete luminal obstruction 3 cm distal from the pyloric ring. Radical cholecystectomy with wedge resection of the liver bed and Whipple's operation was performed. RESULTS: On microscopic examination, the GB mass was well differentiated adenocarcinoma and the duodenal mass was moderately differentiated adenocarcinoma, and one lymph node (a lymph node along the common hepatic artery) among the 18 dissected lymph nodes was invaded by tumor cells. The microscopic findings showed that the GB mass and duodenal mass were synchronous primary carcinomas. The patient recovered uneventfully and is alive and doing well without evidence of recurrence at 21-months of follow up evaluation. CONCLUSIONS: We report here on a case of combined curative resection for synchronous primary carcinomas of the gallbladder and duodenum.
Abdomen ; Adenocarcinoma ; Cholecystectomy ; Diagnosis ; Digestive System ; Duodenum* ; Female ; Follow-Up Studies ; Gallbladder* ; Humans ; Incidence ; Liver ; Lymph Nodes ; Magnetic Resonance Imaging ; Middle Aged ; Phenobarbital ; Recurrence ; Tomography, X-Ray Computed ; Biomarkers, Tumor

BACKGROUND/AIMS: To determine which drug-eluting stents are more effective in acute myocardial infarction (MI) patients with chronic kidney disease (CKD). METHODS: This study included a total of 3,566 acute MI survivors with CKD from the Korea Acute Myocardial Infarction Registry who were treated with stenting and followed up for 12 months: 1,845 patients who received sirolimus-eluting stents (SES), 1,356 who received paclitaxel-eluting stents (PES), and 365 who received zotarolimus-eluting stents (ZES). CKD was defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 calculated by the modification of diet in renal disease method. RESULTS: At the 12-month follow-up, patients receiving ZES demonstrated a higher incidence (14.8%) of major adverse cardiac events (MACEs) compared to those receiving SES (10.1%) and PES (12%, p = 0.019). The ZES patients also had a higher incidence (3.9%) of target lesion revascularization (TLR) compared to those receiving SES (1.5%) and PES (2.4%, p = 0.011). After adjusting for confounding factors, ZES was associated with a higher incidence of MACE and TLR than SES (adjusted hazard ratio [HR], 0.623; 95% confidence interval [CI], 0.442 to 0.879; p = 0.007; adjusted HR, 0.350; 95% CI, 0.165 to 0.743; p = 0.006, respectively), and with a higher rate of TLR than PES (adjusted HR, 0.471; 95% CI, 0.223 to 0.997; p = 0.049). CONCLUSIONS: Our findings suggest that ZES is less effective than SES and PES in terms of 12-month TLR, and has a higher incidence of MACE due to a higher TLR rate compared with SES, in acute MI patients with CKD.
Aged ; *Drug-Eluting Stents/adverse effects ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*etiology/mortality/*therapy ; Paclitaxel/administration & dosage ; Prospective Studies ; Registries ; Renal Insufficiency, Chronic/*complications ; Republic of Korea/epidemiology ; Sirolimus/administration & dosage/analogs & derivatives