Spontaneous fistula formation between the kidney and the colon is uncommon. The underlying cause is usually a pyonephrotic kidney which becomes adherent to a portion of the colon and then ruptures spontaneously, thus creating a fistula. Herein we present a case of renocolonic fistula which occurred in a 36-year old man with review of the literature.
Adult ; Colon ; Fistula* ; Humans ; Kidney ; Rupture

Nephrotic syndrome is associated with a hypercoagulable state, which results in thromboembolism as one of its main complications. Various pathogenetic factors that cause the hypercoagulable state in nephrotic syndrome have been recognized. We report on a 19-year-old female with a minimal-change disease who developed pulmonary thromboembolism combined with intracardiac thrombus while on tapering steroid. Our patient showed hypoalbuminemia with an episode of shock, and was successfully treated with thrombolysis and anticoagulation therapy.
Female ; Humans ; Hypoalbuminemia ; Nephrotic Syndrome* ; Pulmonary Embolism* ; Shock ; Thromboembolism ; Thrombosis* ; Young Adult

BACKGROUND: To evaluate the frequency and clinical significance of lymph node micrometastasis in patients of non-small-cell lung cancer pathologically staged to be T1-2,N0. METHOD: From consecutive 29 patients of non-small-cell lung cancer who received curative operation and routine systemic nodal dissection, we immunohistochemically examined 806 lymph nodes from mediastinal, hilar and peribronchial lesion. All slides were stained with hematoxylin and eosin staining for one section and with cytokeratin AE1/AE3 antibody for another consecutive section of same lymph node to find out micrometastasis. RESULTS: In 806 lymph nodes examined, no tumor cell was seen on hematoxylin and eosin staining and micrometastic foci were shown to be on 0.37%(3) of 806 lymph nodes, in which were upper paratracheal, interlobar and peribronchial lymph node. These three positive stains constitute 10.3%(3) of the 29 patients with non-small-cell lung cancer. Nine patients died from disease progression(4), postoperative complication(3) and concomitant diseases(2). The four patients with disease progression did not show evidence of micrometastasis on their lymph node examination. CONCLUSION: The frequency of lymph node micrometastasis was in 0.37% of 806 lymph nodes examined. The study results might suggested that routine analysis of micrometastasis on the lymph node didn't give any clinical implication on patients with non-small-cell lung cancer.
Coloring Agents ; Disease Progression ; Eosine Yellowish-(YS) ; Hematoxylin ; Humans ; Keratins ; Lung Neoplasms* ; Lung* ; Lymph Nodes* ; Lymphatic Metastasis ; Neoplasm Micrometastasis*

Brown tumor is the benign bone lesion consists of woven bone and fibrous tissue without matrix, which develop due to chronic excessive osteoclastic activity such as hyperparathyroidism. Usually they appear with normal uptake or occasionally focally increased uptake on bone scan. We present a case with brown tumor shown more increased uptake and more number of lesions on bone scan after parathyroidectomy, and lesser increased uptake on serial bone scans without any other treatment through several months. This finding is thought to be similar to 'flare phenomenon' which is occasionally seen after treatment of metastatic bone lesions of malignant cancer, and may represent curative process of brown tumor with rapid normal bone formation.
Hyperparathyroidism ; Osteoclasts ; Osteogenesis ; Parathyroidectomy

PURPOSE: To evaluate normal tonsillar position at different ages, using MR images. MATERIAL AND METHODS: We measured the position of the cerebellar tonsils with respect to the inferior aspect of the foramen magnum on middle sagittal MR T1 weight images in 210 patients(9 days to 83 years) who were not considered to have any disorder that would affect tonsillar position. RESULTS: The mean distance between tonsillar tip and inferior aspect of the foramen magnum was 0.0 +/-1.9mm in the first decade of life, 0.7 +/-2.8mm in the fourth decade, and3.4 +/-2.3 mm in the eighth and ninth decades. The tonsillar position is significantly lower in youth(first and second decades) than in old age(seventh to ninth decades). CONCLUSION: We believe that a single reference standard that indicates the normal distance of the cerebellar tonsils from the foramen magnum is inappropriate unless age is considered. We suggest that the following distance below the foramen magnum(more than 2 standard deviations out of the normal range) be used as criteria for ectopia of the cerebellar tonsils in koreans : firstand second decades, 5mm ; third to sixth decades, 4mm ; seventh and eighth decades, 3mm.
Foramen Magnum ; Palatine Tonsil*

PURPOSE: Peritoneal lavage cytology is regarded as a useful diagnostic test for detecting intraperitoneal micrometastsis. However, there are currently no reports about cytological examination with ThinPrep(R) (CY), a newly introduced fluid-based diagnostic system, in patients with advanced gastric cancer (AGC). This study was performed to analyze the clinical significance of intraoperative peritoneal lavage for CY in AGC patients. MATERIALS AND METHODS: 424 AGC patients were suspected to have serosal exposure macroscopically during surgery and they underwent intraoperative peritoneal lavage for CY between 2001 and 2006 at Korea Cancer Center Hospital. The clinical data, pathological data and CY results were collected and analyzed retrospectively. RESULTS: The percentage of cytology positive results was 31.1%, and this was well correlated with the T-stage, N-stage and P-stage. The 3-year survival rates of CY0 and CY1 were 68.1% and 25.9%, respectively. According to the P-stage and CY, the 3-year survival rates were 71.1% in P0CY0, 38.9% in P0CY1, 38.5% in P1/2/3CY0 and 11.0% in P1/2/3CY1. Interestingly, both the P0CY1 and P1/2/3CY0 survival curves were similar figures, but they were significantly different from those of the other groups. Multivariate analysis indicated that CY was an independent, strong prognostic factor for survival, as well as sex, the T-stage, N-stage, P-stage, other metastasis and the serum CEA. CY1 was revealed as a risk factor for peritoneal recurrence in the curative resection group. CONCLUSION: The results certify indirectly that cytological examination using ThinPrep(R) is a very reliable diagnostic method for detecting intraperitoneal micrometastasis from the fact that it is not only a strong prognostic factor, but it is also a risk factor for peritoneal recurrence in AGC patients. Therefore intraoperative peritoneal lavage should be included in the routine intraoperative staging workup for AGC, and its result will provide a good target for the treatment of peritoneal micrometastasis.
Diagnostic Tests, Routine ; Humans ; Korea ; Multivariate Analysis ; Neoplasm Metastasis ; Neoplasm Micrometastasis ; Peritoneal Lavage ; Recurrence ; Risk Factors ; Stomach Neoplasms ; Survival Rate

BACKGROUND AND OBJECTIVES: The impact of multivessel coronary disease (MVD) with chronic total occlusion (CTO) on one-year mortality in patients with acute myocardial infarction (AMI) is not clearly known. We investigated the impact of MVD with concurrent CTO lesion on one-year mortality in patients with AMI. SUBJECTS AND METHODS: We studied 1008 consecutive patients who underwent coronary angiography between November 2005 and December 2008 with a diagnosis of AMI. RESULTS: Among 1008 patients, 432 patients (43%) had MVD, and 88 patients (8.7%) had CTO lesion. The one-year overall mortality was higher in patients with MVD than in patients with single vessel disease (SVD) (10.2% vs. 5.9%, p=0.012). However, the one-year overall mortality was not significantly higher in patients with CTO lesion than in patients without that lesion (12.5% vs. 7.3%, p=0.080). In multivariate analysis, independent predictors of one-year overall mortality were age older than 65 years {hazard ratio (HR) 2.41, 95% confidence interval (CI): 1.43 to 4.08}, Killip class > or =III (HR 3.59, 95% CI: 2.24 to 5.77), ST-elevation myocardial infarction (HR 2.45, 95% CI: 1.49 to 4.05) and MVD (HR 1.76, 95% CI: 1.07 to 2.89). CONCLUSION: Patients with MVD showed higher one-year mortality than patients with SVD. However, the presence of CTO was not an independent predictor of one-year mortality in this study that included patients with successfully revascularized CTO lesion.
Chronic Disease ; Coronary Angiography ; Coronary Disease ; Coronary Occlusion ; Glycosaminoglycans ; Humans ; Multivariate Analysis ; Myocardial Infarction ; Prognosis

Infradiaphragmatic extralobar pulmonary sequestration is an extremely rare congenital malformation. It is more frequently diagnosed in the antenatal period due to routine ultrasonic examination of the fetus or in the first 6 months of life, though on rare occasions it is discovered incidentally in adults. A 32-yr-old man presenting with epigastric discomfort and fever was referred. Computed tomographic scanning showed that a 16-cm, multiseptated, dumbbell-shaped, huge cystic tumor was located beneath the diaphragm. On the next day, 850 mL of thick yellowish pus was drained by sonography-guided fine needle aspiration for the purpose of infection control and diagnosis, but no microscopic organisms were found in repeated culture studies. Surgical removal of the cyst was performed through thoracoabdominal incision and most of these pathologic lesions were removed but we could not find the feeding arteries or any fistulous tract to surrounding structures. Histopathologic study revealed that it was extralobar pulmonary sequestration and culture study showed that many WBC and necrotic materials were found but there were no microorganisms in the cystic contents. We report the first case of an infected infradiaphragmatic retroperitoneal extralobar sequestration which was administered a staged management and achieved an excellent clinical course.
Adult ; Bronchopulmonary Sequestration/complications/*pathology/surgery ; Diaphragm/abnormalities ; Humans ; Infection/complications/pathology ; Male ; Retroperitoneal Space/abnormalities

PURPOSE: Diabetes mellitus is one of the most common causes of erectile dysfunction (ED). The pathogenesis of ED in diabetic patients is not clear, although vasculogenic and neurogenic factors are involved. This study was designed to further characterize the pathophysiologic manifestations of ED in diabetic patients. MATERIALS AND METHODS: Fifty-seven important patients aged 20 to 71 (mean 45) years participated in this study. On the basis of their medical history, physical examination, and multidisciplinary impotence work-ups, patients were divided into diabetic (n=25) and non-diabetic (psychogenic; n=32) groups. To evaluate vasculogenic manifestations, a pharmacological erection test and penile duplex ultrasonography were performed. To evaluate neurologic manifestations, nicotinamide adenine dinucleotide phosphate (NADPH) diaphorase staining was performed on cavernous tissue samples obtained by percutaneous biopsy. Staining was assessed by counting the number of nitric oxide synthase (NOS)-containing nerve fibers present in four random fields (power 400x). In the diabetic group, we additionally assessed the duration of diabetes, the duration of treatment, and the latency between the onst of ED and the time diabetes was diagnosed. RESULTS: The pathophysiologic causes for ED in the diabetics proved to be neurogenic in 44%, vasculogenic in 20%, and mixed (combined neurogenic and vasculogenic) in 36%. Vascular assessment in the diabetics showed that penile rigidity was decreased and end-diastolic velocity was increased compared with the nondiabetics. Latency to the onset of ED from the diagnosis of diabetes was 0 to 15 (average 5.3) years, and it was closely correlated with the status of NOS-containing nerves (p<0.05). The status of NOS-containing nerves also correlated well with the degree of diabetic control but not with the control method. CONCLUSIONS: Diabetes causes ED by a variety pathophysiologic mechanisms, including neurogenic, vasculogenic, or both. Early and appropriate control of diabetes is required to prevent ED.
Biopsy ; Diabetes Mellitus ; Diagnosis ; Erectile Dysfunction* ; Humans ; Male ; NADP ; Nerve Fibers ; Neurologic Manifestations ; Nitric Oxide Synthase ; Penile Erection ; Physical Examination ; Ultrasonography

Septic arthritis is the infection of a joint by an infectious agent, leading to arthritis. It is therefore important to identify and treat the correct bacteria in septic arthritis. However, accurate identification of bacteria by conventional methods is difficult because of the distinct biochemical characteristics of individual bacteria. This case report aims at assessing septic arthritis caused by Streptococcus dysgalactiae subsp. equisimilis(SDSE) using nucleotide sequences and discusses the associated treatment. Here, Streptococcus agalactiae was determined to be the causative bacteria for septic arthritis in a 77 year-old woman using the conventional method of hemolysis pattern interpretation and morphology. However, nucleotide sequence analysis of 16S ribosomal RNA revealed that SDSE was the causative strain. 16S rRNA gene sequencing can correctly identify bacteria strains that are difficult to be identified by traditional method, and this correct identification can provide patients with the opportunity for adequate treatment using the proper antibiotics.
Anti-Bacterial Agents ; Arthritis ; Arthritis, Infectious ; Bacteria ; Base Sequence ; Female ; Genes, rRNA* ; Hemolysis ; Humans ; Joints ; Knee* ; Methods ; RNA, Ribosomal, 16S ; Streptococcus agalactiae ; Streptococcus*