Neuroendocrine tumor (NET) of the colon and rectum has been reported to have a low incidence and aggressive progression; it is frequently misdiagnosed and its treatment is not well documented. Four NET cases were collected at our hospital during the previous year of a colon cancer survey. Endoscopic mucosal biopsy of the colon was done for each case and all the cases proved to be adenocarcinomas. Curative surgery was conducted after the preoperative diagnostic and staging evaluation was completed. The locations of the primary lesions of the patients were all different; cecum, ascending colon, splenic flexure colon and sigmoid colon. The disease was advanced in all cases and the first postoperative diagnosis was poorly differentiated adenocarcinoma. Immunohistochemical tests followed and all the cases were positive for chromogranin A staining. A retrospective study was then conducted.
Adenocarcinoma ; Biopsy ; Cecum ; Chromogranin A ; Colon* ; Colon, Ascending ; Colon, Sigmoid ; Colon, Transverse ; Colonic Neoplasms ; Diagnosis ; Humans ; Incidence ; Neuroendocrine Tumors* ; Rectum ; Retrospective Studies

We have performed 190 renal transplantations from August 1990 to June 1996. No cadaveric donor was used and all except one were first grafts. We conducted a clinical analysis, especially concerning the factors affecting acute rejection and graft function at 1 year. The results were as follows : 1) The mean ages of donor and recipient were 35.3 years and 37.4 years respectively. The ratio of male to female was 1.4 : 1 and 1.5 : 1, respectively. 2) One hundred and six cases(55.8%) were living unrelated donors and eighty four cases(44.2%) were living related donors. 3) One hundred and sixty six potential recipients were given 3 donor specific transfusions(DST), started about 5 weeks prior to transplantation with cyclosporin coverage. Six of these patients(3.6%) developed sensitization by DST that precluded the subsequent transplantation and the remaining 160 patients received the kidney from the blood donors. Another 28 recipients were given DST 24 hours prior to operation. 4) Most of initial acute rejection episodes(71 episodes, 95%) appeared within the first month of post-transplantation. 5) We analyzed the possible factors affecting the incidence of acute rejection. Donor age and HLA incompatibility were significant statistically(p<0.05). 6) Multiple regression analysis showed that a number of acute rejection episodes(p<0.001) was the only independent risk factor for the graft function at 1 year. 7) Overall graft and patient survival rate were 97.2% and 98.6% at 1 year, 94.1% and 95.5% at 3 years.
Blood Donors ; Cadaver ; Cyclosporine ; Female ; Humans ; Incidence ; Kidney ; Kidney Transplantation* ; Male ; Risk Factors ; Survival Rate ; Tissue Donors ; Transplants ; Unrelated Donors

Tailgut cyst is a rare congenital lesion in retrorectal space. The clinical significance of tailgut cyst presents its morbidity that occurs in the unrecognized and incompletely treated lesion. A forty four year-old female patient visited with lower abdominal pain during defecation. Preoperative abdominopelvic MRI and endorectal ultrasonography revealed a retrorectal mass suggestive of leiomyoma, dermoid cyst, teratoma, or duplication cyst of rectum. She underwent complete resection of retrorectal mass by transsphincteric approach. The mass was multilocular cyst lined by multiple types of epithelium. It was histologically confirmed as a tailgut cyst. She recovered uneventfully. This report includes the case and a brief review of tailgut cyst.
Abdominal Pain ; Defecation ; Dermoid Cyst ; Epithelium ; Female ; Humans ; Leiomyoma ; Magnetic Resonance Imaging ; Rectum ; Teratoma ; Ultrasonography

BACKGROUND AND OBJECTIVES: The level of thyroid-stimulating hormone (TSH)-stimulated thyroglobulin (Tg) after thyroid hormone withdrawal (THW) is the most sensitive marker for detecting recurrence of differentiated thyroid cancer (DTC). In DTC, Tg production is regulated by TSH; however, TSH values after THW are never identical, even in the same patient. The objective of this study was to evaluate the influence of TSH on Tg levels after THW. MATERIALS AND METHODS: TSH and Tg concentrations were measured twice at 2 and 3 weeks after THW in 309 patients with DTC. TSH and Tg levels at these time points were compared. The percent change in TSH (ΔTSH) and change in Tg level (%ΔTg) from 2 to 3 weeks after THW were calculated, and Pearson's correlation coefficients were calculated to determine whether ΔTSH could affect %ΔTg. Tg cutoff value for diagnostic imaging was 2 ng/mL. RESULTS: The TSH and Tg values at 3 weeks were significantly higher than those at 2 weeks after THW. Tg values increased significantly to >2 ng/mL after 1 week in 38.5% of the patients with Tg values of 0.2-2 ng/mL at 2 weeks after THW. In patients with Tg values ≥2 ng/mL at 2 weeks after THW, Tg values increased significantly after an additional week of THW. ΔTSH correlated significantly with %ΔTg. CONCLUSION: TSH values differed according to time after THW, and Tg values differed significantly according to TSH values. Therefore, TSH values should be considered carefully when interpreting the meaning of Tg levels in patients with DTC.
Diagnostic Imaging ; Humans ; Recurrence ; Thyroglobulin* ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyrotropin*

BACKGROUND: The number of patients with pulmonary disease caused by nontuberculous mycobacteria (NTM) has been increasing worldwide. The aim of this study was to evaluate long-term trends in the NTM recovery rate from respiratory specimens over a 10-year period in a tertiary referral hospital in South Korea. METHODS: We retrospectively reviewed the records of mycobacterial cultures of respiratory specimens at Samsung Medical Center from January 2001 to December 2011. RESULTS: During the study period, 32,841 respiratory specimens from 10,563 patients were found to be culture-positive for mycobacteria. These included 12,619 (38%) Mycobacterium tuberculosis and 20,222 (62%) NTM isolates. The proportion of NTM among all positive mycobacterial cultures increased from 43% (548/1,283) in 2001 to 70% (3,341/4,800) in 2011 (p<0.001, test for trend). The recovery rate of NTM isolates from acid-fast bacilli smear-positive specimens increased from 9% (38/417) in 2001 to 64% (1,284/1,997) in 2011 (p<0.001, test for trend). The proportion of positive liquid cultures was higher for NTM than for M. tuberculosis (p<0.001). The most frequently isolated NTM were Mycobacterium avium-intracellulare complex (53%) and Mycobacterium abscessus-massiliense complex (25%). CONCLUSION: The recovery rate of NTM from respiratory specimens in South Korea has increased steadily.
Epidemiology ; Humans ; Korea ; Lung Diseases ; Mycobacterium ; Mycobacterium avium Complex ; Mycobacterium tuberculosis ; Nontuberculous Mycobacteria* ; Republic of Korea* ; Retrospective Studies ; Tertiary Care Centers* ; Tuberculosis

Background: Riehl’s melanosis of the face and neck has been reported in middle-aged women who have darker skin types. Recently, cases of Riehl’s melanosis have been on the rise in Korea, which might reflect the increased use of various cosmetic products and procedures. Objective: This study was designed to analyze the clinicopathological characteristics and treatment outcomes of Riehl’s melanosis in Korean patients. Methods: We closely observed 80 patients with Riehl’s melanosis diagnosed in Asan Medical Center and Hanyang University Medical Center between 2005 and 2015. A skin biopsy was analyzed in 51 patients, and a patch test was carried out in 16 patients. Results: Patients with chronic Riehl’s melanosis (＞12 months) had an increased frequency of previous laser treatments. Patients with acute Riehl’s melanosis (＜3 months) reported a previous history of dry skin, itching, or irritation as a result of the use of hair dye. Patients older than 50 years, with darker skin type, and with a longer disease duration (＞12 months) had poor response rates. Chronic Riehl’s melanosis may be preceded by repeated irritation of barrier-compromised skin, and acute Riehl’s melanosis seems to be an allergic form of Riehl’s melanosis. Conclusion Riehl’s melanosis has different clinical manifestations according to disease duration and different treatment responses based on disease duration.

PURPOSE: The purpose of this research was to evaluate the factors predicting recurrence and the characteristics of patients who recurred after the treatment of spontaneous paroxysmal supraventricular tachycardia (PSVT) with adenosine. METHODS: From January 1999 to December 2001, 62 patients with PSVT were enrolled in this study. The conversion group included patients who had had a therapeutic response, which was defined as the occurrence of a change in the sinus rhythm after adenosine administration. The recurred group consisted of all patients who had not had a therapeutic response. Clinical features, the results of treatment, ECG findings, and the hemodynamic statuses were analyzed. RESULTS: The treatments were vagal maneuver (5 pts, 7.5 %), adenosine 6 mg (37 pts, 55.2 %), adenosine 12 mg (14 pts, 20.9 %), verapamil 5 mg (9 pts, 13.4 %), and cardioversion (2 pts, 3.0 %). Twenty-five of the 62 patients failed to have a therapeutic response, yielding a recurrence rate of 40.3 %. Atrioventricular reentrant tachycardia (AVRT) was more prevalent in the recurred group. The most common symptom at presentation was chest pain. The recurred group had increased heart rate, and increased blood pressure. When patients were monitered after adenosine, unifocal premature ventricular complex was the most common rhythm encountered in the conversion group, but atrial fibrillation, and multifocal premature ventricular complex was the most common rhythm encountered. CONCLUSION: Age, heart rate, difference in systolic blood pressure from presentation to discharge, previous history of heart disease, and rhythms encountered after adenosine administration were factors predicting recurrence.
Adenosine ; Atrial Fibrillation ; Blood Pressure ; Chest Pain ; Electric Countershock ; Electrocardiography ; Emergencies* ; Emergency Service, Hospital* ; Heart Diseases ; Heart Rate ; Hemodynamics ; Humans ; Recurrence* ; Tachycardia ; Tachycardia, Supraventricular ; Ventricular Premature Complexes ; Verapamil

Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive inflammatory process that is characterized by thickening of the gallbladder (GB) wall with a tendency to adhere to neighboring organs. XGC is often mistaken for GB carcinoma, and the frequency of the coexistence of these two lesions is approximately 10%. Therefore, in case of severe XGC, there is chance of either overlooking the carcinoma or other significant lesions. CA 19-9 is commonly measured in the serum of patients with hepatobiliary malignancies. Although CA 19-9 can be elevated in benign conditions such as cholestasis, pancreatitis, tuberculosis, thyroid disease etc., malignancy should be considered at first in setting of its significant and persistent elevation. We report a case of a 62-year-old man who showed continuously rising level of CA19-9 over 2000 U/mL after cholecystectomy for xanthogranulomatous cholecystitis and finally was diagnosed as cholangiocarcinoma by short-term follow up.
Bile Duct Neoplasms/*diagnosis/pathology/radiography ; *Bile Ducts, Intrahepatic ; CA-19-9 Antigen/*blood ; Cholangiocarcinoma/*diagnosis/pathology/radiography ; Cholecystitis/pathology/*surgery ; Granuloma/pathology/*surgery ; Humans ; Male ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed ; Xanthomatosis/pathology/*surgery

We report an unusual case of probable Creutzfeldt-Jakob disease (CJD) in hemodialysis patient. A woman 59 years of age with a past history of hypertension and end-stage renal disease presented with a stuporous state preceded by rapidly progressive cognitive dysfunction, myoclonus, and akinetic mutism. At first, the cause of the altered mental status was assumed to be uremic or hypertensive encephalopathy combined with fever. Proper managements, however, did not improve the neurologic symptoms. Diffusion-weighted magnetic resonance imaging revealed bilaterally asymmetric high signal intensity in both basal ganglia and cerebral cortices. Electroencephalography showed diffuse generalized theta-to-delta range slow wave and intermittent medium-to-high voltage complexes with a characteristic triphasic pattern on both hemispheres. Cerebrospinal fluid assay for the 14-3-3 protein was positive and diagnostic of CJD.
14-3-3 Proteins ; Akinetic Mutism ; Basal Ganglia ; Cerebral Cortex ; Creutzfeldt-Jakob Syndrome ; Dialysis ; Electroencephalography ; Female ; Fever ; Humans ; Hypertension ; Hypertensive Encephalopathy ; Kidney Failure, Chronic ; Magnetic Resonance Imaging ; Myoclonus ; Neurologic Manifestations ; Renal Dialysis ; Stupor

A primary leiomyoma in the neural foramen of the lumbar spine is a very rare condition. We examined a 23-year-old female presented with back and right flank pain. A plain radiography showed a well-defined, osteolytic lesion in the L3 body. In addition, MR images showed a mass lesion with intense enhancement, after intravenous injection with contrast material, in the right neural foramen at the L2/3 level. A histopathologic examination of the resected specimen revealed a benign leiomyoma.
Female ; Flank Pain ; Humans ; Injections, Intravenous ; Leiomyoma* ; Lumbar Vertebrae ; Radiography ; Spine* ; Young Adult