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*

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

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

A 37-year-old female patient admitted due to dyspnea on exertion and peripheral edema. For one and a half years, the patient had been taking various drugs and supplements to reduce weight, including amphetamine-like drugs. The patient had no major cardiovascular risk factors except three pack-years of smoking. A chest computed tomography showed a 1.7 cm diameter, capsulated space-occupying lesion in the left ventricle (LV) and 2-dimensional echocardiography showed LV systolic dysfunction (Left ventricular ejection fraction [LVEF], 30%) with a mobile cystic mass (1.1x1.8 cm) that was attached to the LV apex, which was increased in size and number the next day, even with low dose low-molecular-weight heparin. With an increased dose of anticoagulation medication and heart failure management with diuretics and angiotensin receptor II blocker, LV dysfunction was recovered and the LV thrombus disappeared.
Adult ; Amphetamine ; Angiotensins ; Cardiomyopathies* ; Diuretics ; Dyspnea ; Echocardiography ; Edema ; Female ; Heart Failure ; Heart Ventricles ; Heparin, Low-Molecular-Weight ; Humans ; Risk Factors ; Smoke ; Smoking ; Stroke Volume ; Thorax ; Thrombosis* ; Weight Loss*

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*

OBJECTIVE: This study was designed to examine the effects of 3 months of pharmacological treatment on anxiety sensitivity in patients with panic disorder. METHODS: Patients (N=32) who met DSM-IV criteria for panic disorder with or without agoraphobia were treated with paroxetine and/or benzodiazepines for 3 months. Symptom improvement was assessed by using PDSS (Panic Disorder Severity Scale), and anxiety sensitivity using Anxiety Sensitivity Index Revised (ASI-R), Agoraphobic Cognition Questionnaire (ACQ), Body Sensation Questionnaire (BSQ). Ttest, paired T-test, and paired F-test were performed. RESULTS: Patients with panic disorder showed significant reduction in the measurement of severity of illness and anxiety sensitivity after 3 months of pharmacotherapy. However, they still showed higher scores in the ASI-R and ACQ after 3 months of pharmacotherapy compared to normal control subjects. After pharmacotherapy, they showed significant changes in ASI-R after controlling for changes in ACQ and BSQ. CONCLUSIONS: This study suggests that short-term pharmacological treatment is effective on anxiety sensitivity reduction in panic disorder patients with or without agoraphobia. But this study doesn't show that short-term pharmacological treatment normalizes anxiety sensitivity to levels that are characteristic of normal control samples.
Agoraphobia ; Anxiety* ; Benzodiazepines ; Cognition ; Diagnostic and Statistical Manual of Mental Disorders ; Drug Therapy* ; Humans ; Panic Disorder* ; Panic* ; Paroxetine ; Surveys and Questionnaires ; Sensation

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

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