Occult papillary adenocarcinoma of the thyroid is known to be indolent, slow metastatic, and has a good prognosis. Occult thyroid carcinoma presenting as a blood-borne metastasis without obvious cervical lymph node involvement is extremely rare. A 65-year-old male patient was visited for hoarseness, dysphagia, and shortness of breath. Bronchoscopy with biopsy revealed a papillary carcinoma of thyroid by immunohistochemical staining. Head & neck CT revealed that involving both the upper esophagus and the posterior tracheal wall, extending into the mediastinum along the upper thoracic spine at T1-T2. We have experienced a rare case of occult papillary carcinoma which invaded the trachea, esophagus and fascia of thoracic spine. Treatment was initiated with radioactive iodine and external bean therapy.
Adenocarcinoma, Papillary ; Aged ; Biopsy ; Bronchoscopy ; Carcinoma, Papillary* ; Deglutition Disorders ; Dyspnea ; Esophagus* ; Fascia ; Head ; Hoarseness ; Humans ; Iodine ; Lymph Nodes ; Male ; Mediastinum ; Neck ; Neoplasm Metastasis ; Prognosis ; Spine ; Thyroid Gland* ; Thyroid Neoplasms ; Trachea*

BACKGROUND AND OBJECT: Cheiro-oral syndrome (COS) is characterized by a sensory disturbance in the unilateral hand and ipsilateral mouth corner. It is usually due to a lesion in the parietal cortex, thatamocortical projections, thalamus, or rarely brain stem. However, the syndrome is relatively unknown and rarely mentioned in most neurological textbooks. We presented ten cases of COS with a review of the clinical symptoms and signs and the neuroradiological methods used to demonstrate the responsible site. METHODS AND RESULTS: We studied 10 patients with stroke who showed restricted sensory disturbance on the one hand and ispilateral mouth. The study forms consisted of clinical manifestaion, neurological examination, electrophysiological, and neuroradiologic studies. Computed tomography and/or magnetic resonance imaging identified lesion in the thalamus in 5, brain stem in 3, and corona radiata in 1 patient. But, the anatomical responsible site for one case was not founded. Infarction had occurred in nine cases and hemorrhage in one. Seven of the 10 patients showed sensory disturbances restricted to the perioral area, hands, fingers when they were first examined; the remaining patients complained more diffuse sensory disturbances at first, but it had become restricted to perioral and fingers, usually within 2-3 weeks. The durations of symptom varied from 5 days to more than 15 months and these symptoms were improved within 2-3 weeks to 4 months in treated patients. CONCLUSION: When the symptoms and signs of the COS were presented, especially if a history of migraine is lacking, neuroradiological methods such as CT or MRI should be undertaken to localize and diffentiate the nature of lesion.
Brain Stem ; Fingers ; Hand ; Hemorrhage ; Humans ; Infarction ; Magnetic Resonance Imaging ; Migraine Disorders ; Mouth ; Neurologic Examination ; Rabeprazole ; Stroke ; Thalamus

Anesthesiologists are faced with a growing number of patients in need of cardiac pacing with symptoms of increasing complexity. Because intraoperative pacemaker malfunction can lead to sudden death, it is important for the anesthesiologists to possessthe information necessary to evaluate and treat such patients. On the other hand, torsade de pointes, a particular form of life-threatening polymorphic ventricular tachycardia, is known to be elicited in patients with cardiac pacemakers in the setting of abnormally long QT intervals, decreased heart rate and severe electrolyte disturbances, notably hypokalemia. We herein report a case of intraoperative torsade de pointes that was triggered by pacemaker malfunction-induced bradycardia in a patient with a VVI-type cardiac pacemaker, whose serum potassium and magnesium level were low preoperatively. (Korean J Anesthesiol 1999; 37: 164~167)
Bradycardia ; Death, Sudden ; Hand ; Heart Rate ; Humans ; Hypokalemia ; Magnesium ; Potassium ; Tachycardia, Ventricular ; Torsades de Pointes*

Spontaneous intracranial hypotension, a syndrome of low CSF pressure, occurs without preceding events such as lumbar puncture, back trauma, operative procedure or medical illness. The most characteristic symptom is a headache that may be severe when the patient is upright and relieved when the patient is recumbent. Associated symptoms include neck stiffness, nausea and vomiting, tinnitus, vertigo and subdural effusion or hematoma. This syndrome usually resolves spontaneously or with strict bed rest. When the headache persists or is incapacitating, more aggressive treatment may be necessary. Autologous epidural blood patch is highly effective in the management of spontaneous intracranial hypotension. We report a case of spontaneous intracranial hypotension successfully treated with epidural blood patch.
Bed Rest ; Blood Patch, Epidural* ; Headache ; Hematoma ; Humans ; Intracranial Hypotension* ; Nausea ; Neck ; Spinal Puncture ; Subdural Effusion ; Surgical Procedures, Operative ; Tinnitus ; Vertigo ; Vomiting

BACKGROUND: This study was performed to investigate the clinical usefulness of combined autotransfusion using preoperative autologous donation(PAD) and acute normovolemic hemodilution(ANH) compared with autotransfusion using only PAD in 30 patients undergoing spinal surgery(posterior decompression and fusion). METHODS: Control group(n=15) were transfused with PAD(3 units), and received intra- and postoperative autotransfusion. Combined group(n=15) received ANH(2 units) in addition to above 3 methods applied to control group. Patients were not allowed to predonate or receive ANH if their Hct were below 34%. We applied induced hypotension only to the control group. RESULTS: There were no significant differences between groups in perioperative Hb and Hct levels. Mean volume of autologous blood salvaged by cell saver was significantly greater in combined group(710 ml) than in control group(288 ml). Besides autologous blood, 2.33 units(mean) of homologous blood were used postoperatively in 3 patients of control group and 2 units(mean) of predonated blood were unused and discarded in 3 patients of combined group. CONCLUSION: It appears that combined autotransfusion using PAD and ANH is useful and it increases success rate of autotransfusion.
Blood Transfusion, Autologous* ; Decompression ; Hemodilution* ; Humans ; Hypotension

PURPOSE: To evaluate the benefits of one day, one eye ICL implantation which allows the ICL size of the later-operated eye to be adjusted after evaluating the postoperative vault of the first-operated eye in order to reduce the postoperative ICL size exchange rates of both eyes. METHODS: A total of 426 eyes of 213 patients who received one day, one eye bilateral ICL implantation were included in the present study. The cases where a different ICL size was implanted in the later-operated eye because of high or low postoperative vault of the first-operated eye were analyzed as well as the ICL exchange rates. RESULTS: Among 213 patients, same size ICLs were implanted in both eyes in 188 patients (88%) as planned. However, a different ICL size was implanted in the later-operated eye in 25 patients (12%). Eight eyes of 8 patients out of 25 patients needed their ICL size exchanged during the follow-up period and all 8 eyes were first-operated eyes. This occurred in 8 patients (3.8%) out of 213 patients. CONCLUSIONS: One day, one eye ICL implantation, which can help the size adjustment of the later-operated eye according to the postoperative 1 day vault of the first-operated eye, can reduce the risk of bilateral ICL size exchange operation.
Eye ; Follow-Up Studies ; Humans ; Phakic Intraocular Lenses

Obstruction of the gastrointestinal tract by the progressive fibrotie process of chronic pancreatitis is being recognized with increasing frequency. The structures commonly affected are parapancreatic in location and include the common bile duct in its intrapancreatic portion, the second and third portion of the duodenum and the colon, most commonly the transverse segment. Colonic involvement of varying severity is less common and not well recongnized, and stenosing lesions of the colon are a rare and confusing sequale to pancreatitis. Some cases of colonic stenosis complicated by pancreatitis cannot be differentiated radiologically from carcinoma. The clinical history, enzyme studies and location of the stenosis in the left colon may alert the clinician to this rare diagnosis. We report a patient with stenosis of the colon due to chronic pancreatitis in whom the initial presenting symptoms and radiologic finding resemble colon cancer.
Colon* ; Colonic Neoplasms* ; Common Bile Duct ; Constriction, Pathologic* ; Diagnosis ; Duodenum ; Gastrointestinal Tract ; Humans ; Pancreatitis ; Pancreatitis, Chronic*

BACKGROUND AND OBJECTIVES: T he diagnosis of a nasopharyngeal carcinoma is frequently made at an advanced stage. The anatomic complexicity of the nasopharynx makes a surgical approach difficult, so the radiation therapy is traditionally used as a primary option. Because of the high incidence of a locoregional failure following the radiotherapy and the distant metastasis, the combined treatment modality with the chemotherapy has been applied. The author attempted to investigate the clinical characteristics and the treatment outcomes of nasopharyngeal cancer patients treated with the combination of the radiotherapy and the chemotherapy. SUBJECTS AND METHOD: We retrospectively analyzed 82 patients who were diagnosed with the nasopharyngeal carcinoma in Chonnam National University Hospital. RESULTS: The cumulative survival rates for a 5-year period were 42%. The pathologic type, the clinical stage, the cranial nerve invasion, and the response to the radiotherapy were related to the survival rate of the Kaplan-Meier test (p<0.05). In the Cox proportional hazard model, only the response to radiotherapy was related to the survival rate (p=0.05), as the clinical stage wasn't (p=.06). In the multivariate analysis between the responses to radiation and the clinical factor, the histological type (p=0.018) and the response to the chemotherapy (p=0.021) was statistically significant. CONCLUSION: The response to radiation is the most important in the patient's survival. The clinical stage is a probable prognostic factor. Factors affecting the response to radiation are the histological type and the response to chemotherapy.
Cranial Nerves ; Diagnosis ; Drug Therapy* ; Humans ; Incidence ; Jeollanam-do ; Kaplan-Meier Estimate ; Multivariate Analysis ; Nasopharyngeal Neoplasms* ; Nasopharynx ; Neoplasm Metastasis ; Proportional Hazards Models ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Treatment Outcome

PURPOSE: We investigated the usefulness of urinary pyridinoline (uPyr) and deoxypyridinoline (uDpyr) and serum osteocalcin as markers of bone metastasis, particularly focussing on quantitative correlation between the degree of bone metastasis and the level of biochemical markers. MATERIALS AND METHODS: By using ELISA method we measured the levels of uPyr, uDpyr, and osteocalcin in 100 cancer patients of whom 58 patients had bone metastasis, 42 had no bone metastasis, and 44 control subjects. RESULTS: There was a significant difference in uPyr level between the patients with bone metastasis and the patients without bone metastasis or control group (mean+/-SD, 70.26+/-43.11 vs 38.93+/-21.48 or 25.13+/-8.81 nM/mM Creatinine, p<0.05). And uDpyr level showed more significant elevation in the patients with bone metastasis than in the patients without bone metastasis and in control group (12.63+/-7.51 vs 6.44+/-3.58 and 4.23+/-1.70 nM/mM Creatinine p<0.05). Osteocalcin level showed no significant difference among groups. We could demonstrate a significant quantitative correlation between the extent of bone metastasis and the amount of uPyr (r=0.7482, p<0.001) or uDpyr (r=0.5992, p<0.001). CONCLUSION: uPyr and uDpyr were significantly increased in metastatic bone tumors and quantitatively correlated well with the extent of bone metastasis. Therefore we can use these two markers as an evidence of bone metastasis. Further studies are recommended to decide the usefulness of these markers in the early detection of bone metastasis and in the assessment of response to antiresorptive treatments.
Biomarkers* ; Creatinine ; Enzyme-Linked Immunosorbent Assay ; Humans ; Neoplasm Metastasis ; Osteocalcin

BACKGROUND: We had undergone this study to investigate clinical progress of this disease and to decide the role of aggressive diagnostic approaches, the efficacy of treatments and prognoses. METHODS: A retrospective study was done on 113 patients who had been diagnosed to metastatic adenocarcinoma of pleura by pleural fluid cytology (106 cases) or pleural needle biopsy(22 cases), at Presbyterian Medical Center, from Jan. 1990 to Dec. 1994. RESULTS: 1) The patients were composed of 59 males(52.2%) and 54 females(47.8%), and the mean age distribution was 57.4 +/- 12.1 years. 2) The site of origin was lung cancer 46.9%(53/l 13), stomach cancer 20.4%(23/113), breast cancer 11.5%(13/113), and unknown primary site 6.2%(7/113 cases), as a whole. In male, lung cancer was 55.9%(33/59), stomach cancer was 28.8%(17/59), and in female, lung cancer was 37% (20/54), breast cancer was 24.1% (13/54) of cases. 3) The cardinal symptoms were dyspnea(69%), cough(61%), chest pain(50%), weight loss(50%), anorexia(49%), sputum(43%), malaise(30%). 4) The pleural fluid findings were exudative in 94.4%(102/108), serosanguinous or bloody in 36~53%, unilateral involvement in 74.3%(84/l 13) of cases, and lymphocyte predominance (71 +/- 27%) in differential count of WBC. 5) CEA levels in pleural fluid or plasma were over 10ng/ml in 60.6% (40/66), and ADA levels in pleural fluid were under 40U/L in 95% (57/60) of cases. 6) The patients were managed by various methods, but the efficacy of treatment was uncertain. 7) The mean survival time was 12.7 +/- 13.5 weeks. CONCLUSION: It seems to be no effective treatment methods yet and the prognosis was very poor in this disease, so the objectives of diagnostic approaches and treatment methods should be directed to early diagnosis, treatment and prevention of curable disease. And we must make our best endeavors to lengthen the survival time and improve the quality of patients' life.
Adenocarcinoma* ; Age Distribution ; Breast Neoplasms ; Early Diagnosis ; Female ; Humans ; Lung Neoplasms ; Lymphocytes ; Male ; Needles ; Plasma ; Pleura* ; Prognosis ; Protestantism ; Retrospective Studies ; Stomach Neoplasms ; Survival Rate ; Thorax