PURPOSE: To evaluete the sonographic features of ovarian mass torsion. MATERIALS AND METHODS: We evaluated the sonographic findings in 22 cases of torsioned cystic ovarian mass, benign teratoma(n=21), and normal ovary (n=l) confirmed surgically on pathologically. We classified the ovarian mass into two groups as sonographic ally cystic (n=15) or non-cystic mass(n=6). The patients were 17-72 years old(mean:36.9). We retrospectively reviewed US examination with respect to (1) free fluid in Douglas pouch, (2)pelvic mass & mass wall thickening, (3)dilated uterine tube, (4)prominent follicles, (5) engorged vessels, and (6)beak-like echo in torsion site. The combined conditions of torsion were uterine myoma(n=l) and intrauterine pregnancy(n=3). RESULTS: In sonogram, sonographic cystic mass (n=15) group showed (1)free fluid in Douglas pouch (9/15), (2)mass wall thickening(6/15), (3)dilated uterine tube(2/15), and sonographic non-cystic mass(n=6) group showed (1) free fluid in Douglas pouch (3/6). In sonogram, torsion of the normal ovary(n=1) showed (1) free fluid in Douglas pouch, and (2) prominent follicles. CONCLUSION: If sonogram of reproductive aged women with acute abdomen show free fluid in Douglas pouch and pelvic mass with wall thickening, ovarian mass torsion is suggested. But clinical features of acute abdomen and clinical diagnosis of torsion are more important than sonographic features.
Abdomen, Acute ; Diagnosis ; Douglas' Pouch ; Fallopian Tubes ; Female ; Humans ; Ovary ; Retrospective Studies ; Ultrasonography*

Bile* ; Child, Preschool* ; Female* ; Humans

STUDY DESIGN: Case report OBJECTIVES: We report a case of a female patient who had only upper back pain without neurological symptoms and was later diagnosed with spine tuberculosis in combination with a compression fracture. SUMMARY OF LITERATURE REVIEW: Spine tuberculosis is the most common type of musculoskeletal tuberculosis. However, the indolent nature of tuberculous bone and joint disease often leads to delayed diagnosis and severe neurologic complications. MATERIAL AND METHODS: A 37-year-old female with only upper back pain for five months was admitted. She had no signs, symptoms or past histories related to tuberculosis. She had taken conservative management, but symptoms persisted. RESULTS: By doing motor and sensory evoked potential studies, we questioned spinal cord jury. Then, we confirmed spine tuberculosis T5 with T4 compression fracture by thoracic magnetic resonance imaging and pathologic findings. CONCLUSIONS: When a patient presents constant back pain without neurological symptoms, image study and electromyography should be evaluated.
Adult ; Back Pain ; Delayed Diagnosis ; Electromyography ; Evoked Potentials ; Female ; Fractures, Compression ; Humans ; Joint Diseases ; Magnetic Resonance Imaging ; Spinal Cord ; Spine ; Spondylitis ; Tuberculosis ; Tuberculosis, Spinal

PURPOSE: This study discusses the treatment of premature ejaculation (PE) using various approaches with the goal of evaluating the methods of diagnosis and treatment of PE in clinical practice in 2014 in South Korea. MATERIALS AND METHODS: We surveyed 200 urologists and andrologists who treated patients with PE from July 1, 2014 to July 29, 2014 using an online questionnaire. The questionnaire was composed of 4 parts: disease, comorbidities, diagnosis, and treatment. Using the answers to this survey, current trends in the diagnosis and treatment of PE were investigated using weighted averages. RESULTS: The median number per month of patients who were diagnosed with PE was 14 patients (interquartile range, 7~24). The time to ejaculation necessary for a diagnosis of PE was considered to be <1 minute by 12% of respondents, <2 minutes by 27%, <3 minutes by 28%, <5 minutes by 13%, and 20% stated that diagnosis was based on a patient's subjective complaint. The treatment methods preferred by PE patients were reported to be pharmacological treatment (87%), surgical treatment (9.5%), and behavioral management (3.5%). The treatment methods used by respondents were pharmacological treatment (77%), surgical treatment (15%), and behavioral management (14%). The most commonly used pharmacological treatment was the oral administration of dapoxetine (97%). CONCLUSIONS: In 2014 in South Korea, various methods were used to diagnose and treat PE. The most commonly used treatment for PE was the oral administration of dapoxetine. It was also found that surgical treatment was applied in some cases.
Administration, Oral ; Comorbidity ; Diagnosis* ; Ejaculation ; Humans ; Korea* ; Male ; Premature Ejaculation* ; Surveys and Questionnaires

A multilocular cyst of kidney is a rare pathological entity, which has been reported in the literature under several names. These various names reflect the controversy surrounding their nature. This tumor is traditionally regarded as benign in nature and a nephrectomy has to be performed because of the difficulty in its accurate diagnosis. Malignant recurrence of a multilocular cyst of kidney has an even rarer incidence, with only a few cases having been reported. We report a case of 50-year-old male, with an incidentally detected right renal cystic mass. This mass was pathologically confirmed as a multilocular cyst of kidney after a radical nephrectomy, which locally recurred as a malignant mesoblastic nephroma.
Diagnosis ; Humans ; Incidence ; Kidney Diseases, Cystic ; Kidney* ; Male ; Middle Aged ; Nephrectomy ; Nephroma, Mesoblastic ; Recurrence*

BACKGROUND/AIMS: Anti-viral therapy using hepatitis B immune globulin and lamivudine could not prevent HBV recurrence after liver transplantation (LT) completely. Adefovir dipivoxil is a acyclic nucleotide phosphate analogue and known to have potent anti-HBV effect. In this study, we analyzed the therapeutic effect of adefovir for recurrent or de novo HBV infection after LT. METHODS: From December 2002 to October 2004, adefovir was administered in 12 post-LT patients of HBV infection (11 recurrent and 1 de novo infection). In these patients, lamivudine and other combined therapies were used before the introduction of adefovir. Thereafter, adefovir combined with lamivudine was administered to all patients. RESULTS: The duration of adefovir administration was 5.5-18 (median, 15.5) months. The median values of serum AST and ALT levels were significantly reduced from 86+/-80 IU/L and 140+/-103 IU/L, respectively before the adefovir administration to 42+/-19 IU/L and 38+/-33 IU/L after 2 months of administration. This trend of improved liver function persisted throughout the follow-up period. HBeAg seroconversion was achieved in 4 of 10 patients (40%) and HBsAg seroconversion was observed in 1 of 10 patients (10%). HBV DNA levels have decreased to undetectable levels by hybridization assay in 6 of 7 patients within the first 2 months of therapy. Nephrotoxicity and hypophosphatemia were not found in all of these patients. CONCLUSIONS: Based on this preliminary result, adefovir dipivoxil seems to be an effective and safe antiviral agent leading to viral inhibition and clinical improvement in post-LT patients with recurrent or de novo HBV infection.
Adenine/administration & dosage/*analogs & derivatives ; Adult ; Antiviral Agents/*administration & dosage ; Drug Therapy, Combination ; English Abstract ; Female ; Hepatitis B, Chronic/*drug therapy ; Humans ; Lamivudine/administration & dosage ; *Liver Transplantation ; Male ; Middle Aged ; Phosphonic Acids/*administration & dosage ; Recurrence ; Reverse Transcriptase Inhibitors/administration & dosage

Histiocytic sarcoma is a rare malignant neoplasm that originates from a histiocytic hematopoietic lineage characterized by histiocytic differentiation and its corresponding immunophenotypic features. Patients with histiocytic sarcoma usually have a poor prognosis due to its aggressive clinical behavior. Here we report a rare case of extranodal histiocytic sarcoma of the stomach which was confirmed through immunohistochemical staining. A 71-yearold man was presented with epigastric pain. Gastroscopy, abdominal CT, and EUS revealed a mass located on the posterior wall of upper body and fundus of the stomach. Grossly, grayish white solid masses were seen extending down to the submucosal layer. Microscopically, the tumor cells had eosinophilic cytoplasm, abundant vacuole, and mitosis. Immunohistochemical staining revealed that the tumor cells were positive for LCA, CD68, and lysozyme. Early detection and accurate diagnosis of this rare neoplasm is important because it can make a great difference in prognostic outcomes. To make an accurate and definitive diagnosis, immunohistochemical staining is essential in the confimation of histiocytic orign.
Adenocarcinoma/diagnosis/pathology/ultrasonography ; Aged ; Antigens, CD/metabolism ; Antigens, CD45/metabolism ; Antigens, Differentiation, Myelomonocytic/metabolism ; Diagnosis, Differential ; Gastroscopy ; Histiocytic Sarcoma/*diagnosis/pathology/ultrasonography ; Humans ; Male ; Muramidase/metabolism ; Stomach Neoplasms/*diagnosis/pathology/ultrasonography ; Tomography, X-Ray Computed

BACKGROUNDS/AIMS: Pneumatosis intestinalis (PI) is a condition in which multiple gas-filled mural cysts develop in the gastrointestinal tract. Although its exact etiology remains obscure, PI is rarely observed in liver transplant (LT) recipients. METHODS: In 317 cases of adult living donor LT (LDLT) performed during 2011, PI developed in three patients during the 3 year follow-up. RESULTS: Of these three patients, the two who demonstrated PI at 6 weeks and 2 months after LT, respectively, were asymptomatic and showed no signs of secondary complications. Diagnosis was made incidentally using abdominal radiographs and computed tomography (CT) scans. PI was identified in the right ascending colon with concomitant pneumoperitoneum. These two patients received supportive care and maintained a regular diet. Follow-up CT scans demonstrated spontaneous resolution of PI with no complications. The third patient was admitted to the emergency room 30 months after LDLT. His symptoms included poor oral intake and intermittent abdominal pain with no passage of gas. Abdominal radiography and CT scans demonstrated PI in the entire small bowel, with small bowel dilatation, pneumoperitoneum, and pneumoretroperitoneum, but no peritonitis. Physical examination revealed abdominal distension but no tenderness or rebound tenderness. After 1 week of conservative treatment, including bowel rest and antibiotics therapy, PI and pneumoperitoneum resolved spontaneously without complications. CONCLUSIONS: We suggest that adult LDLT recipients who develop asymptomatic or symptomatic PI with no signs of secondary complications can be successfully managed with conservative treatment.
Abdominal Pain ; Adult* ; Anti-Bacterial Agents ; Colon, Ascending ; Diagnosis ; Diet ; Dilatation ; Emergency Service, Hospital ; Follow-Up Studies ; Gastrointestinal Tract ; Humans ; Liver ; Liver Transplantation* ; Living Donors* ; Peritonitis ; Physical Examination ; Pneumoperitoneum ; Radiography, Abdominal ; Retropneumoperitoneum ; Tomography, X-Ray Computed

BACKGROUNDS/AIMS: Tumor recurrence is very common after hepatic resection of hepatocellular carcinoma (HCC) > or =10 cm. The purpose of this study was to validate the prognostic significance of the preoperative alkaline phosphatase (ALP) level and early intrahepatic metastasis in HCC patients who underwent resection of large HCC. METHODS: Clinical data of 100 large HCC patients who underwent liver resection were retrospectively reviewed. All of them underwent protocol transarterial chemoinfusion (TACI) at 1 month. RESULTS: Median tumor diameter was 13.8 cm, and 94% were single lesions. Systematic and non-systematic resections were performed in 91% and 9%, respectively, with R0 resection achieved in 84%. Overall 1-, 3- and 5-year survival rates were 76%, 38.5%, and 30.4%, respectively. Univariate analyses on patient survival revealed that intrahepatic metastasis on 1-month protocol TACI was the only significant risk factor (p=0.002). Mean ALP values according to the intrahepatic metastasis on 1-month protocol TACI were 124.6+/-76.9 IU/L and 145.1+/-92.6 IU/L, which did not show a statistical difference (p=0.23). CONCLUSIONS: In patients with large HCC, 1-month protocol TACI combined with hepatic resection may contribute to the early detection and timely treatment of potentially preexisting metastatic lesions.
Alkaline Phosphatase ; Carcinoma, Hepatocellular* ; Humans ; Liver ; Neoplasm Metastasis* ; Recurrence ; Retrospective Studies ; Risk Factors ; Survival Rate

Background/Aims: Multiplication of α-fetoprotein, des-γ-carboxy prothrombin, and tumor volume (ADV score) is a surrogate marker for post-resection prognosis of hepatocellular carcinoma (HCC). This study aimed to validate the predictive power of the ADV score-based prognostic prediction model for patients with solitary huge HCC. Methods: Of 3,018 patients, 100 patients who underwent hepatic resection for solitary HCC ≥13 cm between 2008 and 2012 were selected. Results: The median tumor diameter and tumor volume were 15.0 cm and 886 mL, respectively. Tumor recurrence and overall survival (OS) rates were 70.7% and 66.0% at one year and 84.9% and 34.0% at five years, respectively. Microvascular invasion (MVI) was the only independent risk factor for disease-free survival (DFS) and OS. DFS and OS, stratified by ADV score with 1-log intervals, showed significant prognostic contrasts (P=0.007 and P=0.017, respectively). DFS and OS, stratified by ADV score with a cut-off of 8-log, showed significant prognostic contrasts (P=0.014 and P=0.042, respectively). The combination of MVI and ADV score with a cut-off of 8-log also showed significant prognostic contrasts in DFS (P<0.001) and OS (P=0.001) considering the number of risk factors. Prognostic contrast was enhanced after combining the MVI and ADV score. Conclusions The prognostic prediction model with the ADV score could reliably predict the risk of tumor recurrence and long-term patient survival outcomes in patients with solitary huge HCC ≥13 cm. The results of this study suggest that our prognostic prediction models can be used to guide surgical treatment and post-resection follow-up for patients with huge HCCs.