Wernicke's encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke's encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke's encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.
Acute Kidney Injury ; Adult ; Alcohol Drinking ; Ataxia ; Female ; Humans ; Hyperemesis Gravidarum* ; Neurologic Manifestations ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Shock ; Thiamine ; Thiamine Deficiency ; Uterine Hemorrhage ; Wernicke Encephalopathy*

BACKGROUND: A number of recent reports have described the usefulness of the epidural injection of narcotics for the relief of postoperative pain. Morphine, a u-receptor agonist, produce strong analgesic effect with some side effects. Nalbuphine, is a u-antagonist and k-agonist, has an analgesic effect comparable to morphine with little side effects. METHOD: We divided 60 patients into 3 groups utilizing the five-day Baxter Infusor in 0.125% bupivacaine at 0.5 ml/hr: 1) Group M (n=20) received initial 2 mg of bolus + 2 mg/day of maintenance morphine 2) Group N(n=20); initial 4 mg of bolus + maintenance 8 mg/day nalbuphine 3) Group M+N(n=20); initial 2 mg morphine of bolus + maintenance 8 mg/day nalbuphine. Analgesic effect was evaluated by visual analogue scale(0-10) at 6, 12, 18, 24 and 48 hour postoperatively. Changes in blood pressure, heart rate, and incidence of side effects were observed. RESULTS: No significant hemodynamic changes were seen in any of the groups. The patients of group M and M+N get less pain than group N but side-effects of group M were significantly more than group N, M+N. CONCLUSIONS: Nalbuphine hydrochloride could be better agent than morphine in terms of complication and the dose of group M+N (initial morphine 2mg of bolus + maintenance 8 mg/day nalbuphine) may be recommended for postoperative analgesia.
Analgesia ; Blood Pressure ; Bupivacaine ; Heart Rate ; Hemodynamics ; Humans ; Incidence ; Infusion Pumps ; Injections, Epidural ; Morphine* ; Nalbuphine* ; Narcotics ; Pain, Postoperative*

PURPOSE: This study was aimed to determine the predictive risk factors for the treatment response and relapse rate in children diagnosed with idiopathic nephrotic syndrome. METHODS: We analyzed the medical records of children who were diagnosed and treated for childhood idiopathic nephrotic syndrome from November 1991 to May 2005. Variables selected in this study were age at onset, sex, laboratory data, concomitant bacterial infections, days to remission, and interval to first relapse. RESULTS: There were 46 males and 11 females, giving a male:female ratio of 4.2:1. The age(mean+/-SD) of patients was 5.8+/-4.1 years old. Of all patients who were initially given corticosteroids, complete remission(CR) was observed in 54(94.7%). Of the 54 patients who showed CR with initial treatment, 40(70.2%) showed CR within 2 weeks and 14(24.6%) showed CR after 2 weeks. The levels of serum IgG were lower in the latter group who showed CR after 2 weeks(P=0.036). Of the 54 patients who showed CR with initial treatment, 47(82.5%) relapsed. Of these patients, 35.1% were frequent relapsers and 43.9% were infrequent relapsers. There was no significant correlation between the frequency of relapse and the following variables:sex, days to remission, and laboratory data. However, age at onset and interval to first relapse had a negative correlation with the frequency of relapse (Pearson's coefficient=-0.337, -0.433, P<0.012, P<0.01). CONCLUSION: The age at onset and the interval to first relapse were found to be predictive clinical parameters for the relapse rate, while the levels of serum IgG at initial presentation were a predictive laboratory factor for treatment response in childhood idiopathic nephrotic syndrome.
Adrenal Cortex Hormones ; Bacterial Infections ; Child ; Female ; Humans ; Immunoglobulin G ; Male ; Medical Records ; Nephrotic Syndrome* ; Recurrence* ; Risk Factors

Purpose: To identify the indication for recommending prebiopsy magnetic resonance imaging (MRI) to prevent prostate cancer missed diagnoses in cases without prebiopsy MRI. Materials and Methods: Between January 2017 and September 2020, 585 patients suspected with prostate cancer underwent prostate biopsy after MRI. For patients with visible lesions, MRI-targeted biopsy using an image-based fusion program was performed in addition to the 12- core systematic biopsy. Patients for whom MRI was performed in other institutions (n=4) and patients who underwent target biopsy alone (n=7) were excluded. Results: Of 574 patients (median prostate-specific antigen [PSA] level, 6.88 ng/mL; mean age, 68.2 years), 342 (59.6%) were diagnosed with prostate cancer (visible lesions=312/449 [69.5%]; nonvisible lesions=30/123 [24.0%]). The detection rates of visible lesions stratified using the Prostate Imaging Reporting and Data System score (3 vs. 4 vs. 5) were 30.9% (54 of 175), 61.2% (150 of 245), and 90.1% (127 of 141), respectively. Multivariate analysis showed that PSA density was a significant factor for presence of visible lesions, prostate cancer, and significant prostate cancer diagnosis. Among patients with positive lesions, 27 (8.2%) were diagnosed with prostate cancer concomitant with negative systematic biopsy results. A PSA density of 0.15 ng/mL/cm3 was identified as the significant cutoff value for predicting positive target biopsy in groups with negative systematic biopsy. Sixty of the negative target lesions (26.1%) were diagnosed using systematic biopsy. Conclusions To maximize cancer detection rates, both targeted and systematic biopsies should be implemented. PSA density was identified as a useful factor for recommending prebiopsy MRI to patients suspected with prostate cancer.

Purpose: To identify the indication for recommending prebiopsy magnetic resonance imaging (MRI) to prevent prostate cancer missed diagnoses in cases without prebiopsy MRI. Materials and Methods: Between January 2017 and September 2020, 585 patients suspected with prostate cancer underwent prostate biopsy after MRI. For patients with visible lesions, MRI-targeted biopsy using an image-based fusion program was performed in addition to the 12- core systematic biopsy. Patients for whom MRI was performed in other institutions (n=4) and patients who underwent target biopsy alone (n=7) were excluded. Results: Of 574 patients (median prostate-specific antigen [PSA] level, 6.88 ng/mL; mean age, 68.2 years), 342 (59.6%) were diagnosed with prostate cancer (visible lesions=312/449 [69.5%]; nonvisible lesions=30/123 [24.0%]). The detection rates of visible lesions stratified using the Prostate Imaging Reporting and Data System score (3 vs. 4 vs. 5) were 30.9% (54 of 175), 61.2% (150 of 245), and 90.1% (127 of 141), respectively. Multivariate analysis showed that PSA density was a significant factor for presence of visible lesions, prostate cancer, and significant prostate cancer diagnosis. Among patients with positive lesions, 27 (8.2%) were diagnosed with prostate cancer concomitant with negative systematic biopsy results. A PSA density of 0.15 ng/mL/cm3 was identified as the significant cutoff value for predicting positive target biopsy in groups with negative systematic biopsy. Sixty of the negative target lesions (26.1%) were diagnosed using systematic biopsy. Conclusions To maximize cancer detection rates, both targeted and systematic biopsies should be implemented. PSA density was identified as a useful factor for recommending prebiopsy MRI to patients suspected with prostate cancer.

Leiomyoma is the most common benign tumor of the esophagus, but it still occurs rarely as compared with the incidence of carcinoma in this area. Most of leiomyomas may manifest itself with unusual and inconsistent symptoms, and found incidentally during endoscopic or radiographic examination. Those who menifested symptoms are included as dysphagia and vague pain mostly. We experienced recently two cases with esophageal leiomyoma who underwent successful surgical resection and endoscopic enucleation, respectively.
Deglutition Disorders ; Esophagus* ; Incidence ; Leiomyoma*

A pseudo-Cushing's state can be defined as some or all of the clinical features of Cushing's syndrome together with some evidence for hypercortisolism. It may be related to depression, alcohol abuse and obesity. Its manifestation may be transient and resolved with abstinence from causing factors. We report a case of a 70-year-old woman with unilateral nonfunctioning adrenal adenoma and geriatric depressive disorder, which diagnosed by Geriatric Depression Scale (GDS). She showed clinical and/or biochemical features of Cushing's syndrome. Low dose and high dose dexamethasone suppression tests were not identical to those in ACTH independent Cushing's syndrome. Few cases of pseudo-Cushing's syndrome were reported previously in Korea but there was no report about pseudo-Cushing's syndrome combined with nonfunctional adrenal adenoma.
Adenoma* ; Adrenal Glands ; Adrenocorticotropic Hormone ; Aged ; Alcoholism ; Cushing Syndrome ; Depression ; Depressive Disorder ; Dexamethasone ; Female ; Humans ; Korea ; Obesity

No abstract available.
Hypertension, Renovascular* ; Pheochromocytoma*

Teratomas are embryonal neoplasms that show characteristics from all three germ layers(ectoderm, endoderm, and mesoderm). These tumors are frequently present in infancy and childhood. Teratomas are classified into three groups : mature teratoma, immature teratoma, and teratomas with malignant elements. The histopathologic findings of immature teratoma is primitive neuroepithelial cells compounding pseudostratified tubular formations. The pure immature teratoma accounts for fewer than 1% of all germ cell malignancies. The immature teratomas in nasal cavity are very rare tumor. These tumors are often presented as neonatal respiratory distress, nasal obstruction and epistaxis. We report a case of histologically confirmed immature teratoma in nasal cavity in 48 years old man with review of the literature.
Endoderm ; Epistaxis ; Germ Cells ; Humans ; Middle Aged ; Nasal Cavity* ; Nasal Obstruction ; Neoplasms, Germ Cell and Embryonal ; Neuroepithelial Cells ; Teratoma*

PURPOSE: Helicobacter pylori infection is thought to be correlated with iron-deficiency anemia (IDA) at puberty. The H. pylori feoB gene, a high-affinity ferrous iron transporter, plays a central role in iron acquisition. This study aims to analyze the H. pylori feoB status according to the presence of antral gastritis with or without IDA. METHODS: Fourteen H. pylori-positive patients aged from 10~18 years were categorized into subgroups based on the presence or absence of IDA. Eight patients had IDA, and the other six showed normal hematological findings. Genomic DNA was isolated from cultured H. pylori. Five sets of primers were used for PCR amplification of the feoB gene. The feoB region, 1.93 kb, was generated by linking of the PCR products and sequenced. The feoB gene sequences of H. pylori J99 and 26695 were used to compare with the clinical strains. Sequence comparisons of the feoB regions between the IDA (+) and (-) groups were performed. RESULTS: Sequence analysis of the complete coding region of the feoB revealed 16 sites of polymorphism. Among these, 3 polymorphisms-Glu/Thr254Ala, Ile263Val, and Lys511Gln - were indigenous to Korean strains. Although statistically significant differences appear in 4 sites between IDA (+) and (-), the number of specimens are too low to assess the real differences. CONCLUSION: The 4 polymorphisms in the feoB gene seem to be related with IDA, but it is unclear yet because of small number of study strains. Further studies are required to prove the correlation of IDA and H. pylori infection.
Adolescent ; Anemia, Iron-Deficiency* ; Clinical Coding ; DNA ; Gastritis ; Genes, vif ; Helicobacter pylori* ; Helicobacter* ; Humans ; Iron ; Korea* ; Polymerase Chain Reaction ; Puberty ; Sequence Analysis