Although neuroendocrine differentiation is a characteristic feature of tumors of the adrenal medulla, cortical tumors may also rarely be differentiated into medullary element. Recently we experienced such a case of adrenal cortical tumor having features of both cortical and medullary tumor. The patient was an 11-year-old girl who was incidentally found to have a left adrenal mass. Laboratory results showed elevated serum cortisol, aldosterone, renin, and epinephrine with high excretion of urinary metanephrine. Urine vanillyl mandelic acid and 17-ketosteroid remained within normal limits. Histologic featuresof a 6 cm round yellowish tumor were ambiguous to decide the orgin of this neoplasm. Cortical element predominated in the tumor with minor areas of pheochromocytomatous feature. Immunohistochemically, the tumor cells were positive for vimentin, neuron specific enolase, and epithelial membrane antigen. Ultrastructural examination revealed scattered membrane bound dense core granules in the tumor cells of medullary differentiation, measuring 150~500 nm in average diameter. Cortical tumor element showed corresponding ultrastructural features. These results indicate that this is a case of adrenal cortical tumor with features of neuroendocrine differentiation.
Child ; Male ; Female ; Humans

In order to investigate electrolyte changes in serum and urine diuretic therapy, we studied 98 patients with hypertension not optimally controlled by previous treatment. After we divied the patients into three gorups in randomized trial, group A were given Amiloride 10mg/day, group B were given Dihydrochlorothiazide 50mg/day, group C were given Amiloride 5mg/day combined with Dihydrochlorothiazide 25mg/day for 7 days. Blood pressure and electrolyte changes in serum and urine after diuretic theraphy for 7 days were as follows. 1) Serum sodium concentrations were not significantly changed in all three groups(P>0.05). 2) Serum potassium concentrations were increased in group A and C (P<0.05), but there were no significant changes in group B(P<0.05). 3) Urinary sodium exceretions were increased in all three groups(P<0.05). 4) Urinary potassium excretion were decreased in group A and C (P<0.05), but there were increased in group B (P<0.05). 5) Blood pressure were decreased in all three groups(P<0.05).
Amiloride ; Blood Pressure ; Diuretics* ; Electrolytes* ; Humans ; Hydrochlorothiazide ; Hypertension* ; Potassium ; Sodium

No abstract available.
Headache* ; Humans

We describe a case of the juvenile form of Pompe's disease that presented as primary alveolar hypoventilation due to respiratory muscle involvement. This 17-year-old girl had been asymptomatic until this admission, although she had a delayed puberty. Arterial blood gas analysis, pulmonary function test as well as physical findings were compatible with chronic alveolar hypoventilation syndrome. Since she had lower extremity muscle weakness and pseudomyotonic discharge on electromyography a muscle biopsy was done, which revealed glycogen storage disease. The patient was managed successfully with nasal intermittent positive pressure ventilation.
Adolescent ; Chronic Disease ; Female ; Glycogen Storage Disease Type II/*complications/pathology ; Humans ; Hypoventilation/*etiology/therapy ; Intermittent Positive-Pressure Ventilation ; Muscles/pathology ; Pulmonary Alveoli

Thoracic disc herniation is uncommon and only represents 0.25% to 0.75% of all symptomatic disc lesions. The difficulty in diagnosis has been the one of the major problems in the treatment of thoracic disc herniation. But at now, the use of computed tomography with or without water soluble contrast media makes the diagnosis more acurate. Recently, we diagnosed a case of T4, T5 disc herniation by computed tomography with iopamidol. Operation by transthoracic, transpleural approach was done with microsurgical technique, and the result was good. The case is reviewed and other surgical techniques on the literature is discussed.
Contrast Media ; Diagnosis ; Iopamidol

No abstract available.
Neural Tube Defects* ; Spinal Canal*

Adirect intracranial operative approach with clipping the neck of the aneurysm is generally considered to be the ideal treatment for the intracranial arterial aneurysms. Several strategies exist for treating unclippable aneurysms. Intravascular techniques, proximal occlusion of the parent artery or trapping of the aneurysm, microsurgical bypass of the involved arterial segment, and reinforcement or wrapping of the aneurysmal wall are frequently used. The authors report a case with long term(6 years) follow-up results of the circumferential wrapping with sutures-reinforcement for giant fusiform aneurysm of the internal carotid artery. The giant fusiform aneurysm and ideal wrapping materials were discussed with review of literature.
Aneurysm* ; Arteries ; Carotid Artery, Internal ; Endovascular Procedures ; Follow-Up Studies ; Humans ; Neck ; Parents ; Sutures

A 77-year-old woman was admitted to this hospital for evaluation of chest pain for 3 days. On physical examination, icteric sclerae, inspiratory crackles on both lower lung field and normal heart sounds were observed. Electrocardiograms showed pathologic Q waves with ST elevations in the precordial leads(V1-V4). Chest X-rays showed mild pulmonary edema with anteroseptal wall akinesia. Cardiac enzyme studies were compatible with AMI. Hematologic investigation revealed severe thrombocytopenia and microangiopathic hemolytic anemia. Coagulation profiles were normal. Coombs test, sucrose lysis test, anti-platelet antibody and antinuclear antibody were all negative. Urinalysis showed albuminuria(+++) and microscopic hematuria. Initial therapy with aspirin, nitrate, morphine and prednisolone was started. Ten hours after admission, she developed agitation, aphagia and confusion with progression to coma. Computed tomography of the brain was normal. Five units of fresh frozen plasma were infused. After one day, platelet counts slightly increased. But cardiogenic shock ensued and she died despite cardiopulmonary resuscitation. AMI has not been reported in association with TTP. This patient had no risk factors for coronary artery disease and no previous history of angina. TTP was clinically diagnosed with confidence by excluding other known cause of microangiopathic hemolytic anemia with thrombocytopenia. Coronary angiogram and bone marrow examination could not be performed due to a rapidly fatal course. The etiology of AMI in this patient was not confirmed, but clinical evidence strongly supported etiologic association with TTP.
Aged ; Anemia, Hemolytic ; Antibodies, Antinuclear ; Aspirin ; Bone Marrow Examination ; Brain ; Cardiopulmonary Resuscitation ; Chest Pain ; Coma ; Coombs Test ; Coronary Artery Disease ; Dihydroergotamine ; Electrocardiography ; Female ; Heart Sounds ; Hematuria ; Humans ; Lung ; Morphine ; Myocardial Infarction ; Physical Examination ; Plasma ; Platelet Count ; Prednisolone ; Pulmonary Edema ; Purpura, Thrombotic Thrombocytopenic ; Respiratory Sounds ; Risk Factors ; Sclera ; Shock, Cardiogenic ; Sucrose ; Thorax ; Thrombocytopenia ; Urinalysis

We investigated the vestibulo-ocular reflex which is followed by the change of angular acceleration in sinusoidal harmonic acceleration test. 20 normal volunteers with no evidence of previous otoneurologic disease were tested. The maximal slow phase eye velocity, gain and asymmetry were obtained in five different amplitudes of rotation, 30degrees, 60degrees, 90degrees, 120degrees and 150degrees with properly fixed conditions such as darkness and the frequency of rotation fixed at 0.05Hz. During each test, we asked the examinees to be alert and keep the eyes open. At least 5 minute interval was given between the tests and recalibrations were done before each test. The results of this test were as follows. 1) The maximal slow phase eye velocities were gradually increased according to the increment of the amplitudes of rotation with the statistical significances(p<0.05). 2) The gains were gradually decreased according to the increment of the amplitudes of rotation between the range of 30degrees and 90degrees with the statistical significances(p<0.05). 3) The asymmetries of each amplitude were the highest(13.6%) at 30degrees and the lowest(6.9%) at 120degrees, but there were no statistical significances(p>0.05). Therefore, from the above results, sinusoidal harmonic acceleration test with the frequency fixed at 0.05Hz, gain is higher when the amplitude of rotation is smaller and the pattern of the nystagmus is more evident when the amplitude of rotation is bigger. But The authors conclude that in order to get the results which are statistically significant, the amplitude of rotation should be lower than 90degrees.
Acceleration* ; Darkness ; Healthy Volunteers ; Reflex, Vestibulo-Ocular*

OBJECT: To determine whether to use surgical or medical therapy in treatment of infectious intracranial aneurysms, we reviewed two recent cases of infectious intracranial aneurysms and others known previous reports of aforementioned cases. Hence, we attempted to compare the validity and effectiveness of surgical and medical treatment. METHOD: Recently, we treated two cases of ruptured infectious intracranial aneurysms. In former case, the aneurysm was located distal to the middle cerebral artery in a patient with mild mitral regurgitation of the heart. In latter case, the aneurysm was multiple with varying hemorrhage. The hemorrhage was located bilaterally and a moderate mitral regurgitation and infective endocarditis were accompanied in this patient. RESULT: Due to the large size of the intracranial hematoma, stable medical condition, and easy resectability, we treated the former patient surgically. And, because of successive hemorrhage by multiple aneurysmal rupture, and the risk of heart failure, we treated the latter patient medically with serial follow-up angiography. Both patients are at present in good health. CONCLUSION: Because of the variability in associated factors, such as the patient's health, the number of lesions, location, anatomy of the aneurysms and the causative organism, each patient's care must be individualized and tailored to the patient's particular clinical situation.
Aneurysm ; Angiography ; Endocarditis ; Follow-Up Studies ; Heart ; Heart Failure ; Hematoma ; Hemorrhage ; Humans ; Intracranial Aneurysm* ; Middle Cerebral Artery ; Mitral Valve Insufficiency ; Rupture