Isolated ACTH deficiency is a rare cause of secondary adrenocortical insufficiency caused by the defect of synthesis or release of ACTH in pituitary gland. The clinical presentation can be simiilar to that of primary adrenal insufficiency, but there is a greater tendency for hypoglycemia and absence of hyperpigmentation. The patient, 80 year-old female, was admitted in chief complaint of deteriorated mental states. On admission, serum sodium was 127mEq/L, potassium 4.4mEq/L, blood glucose 27mg/dL and on routine E.C.G. was atrial fibrillation was revealed. The basal morning serum cortisol level was 9.97 pg/dL it dosent respond to insulin-induced hypoglycemia enoughly, but other pituitary functions were intact in pituitary cocktail stimulation test. In CRH stimulation test, there was no remarkable response in serum ACTH and cortisol level. Brain MRI failed to reveal any anatomic abnormalities of the sellar or suprasellar area consistent with the defect of pituitary ACTH secretion. This case was a isolated ACTH deficiency, So, we conclude that associated with atrail fibrillation and hypoglycemia.
Addison Disease ; Adrenocorticotropic Hormone* ; Aged, 80 and over ; Atrial Fibrillation* ; Blood Glucose ; Brain ; Female ; Humans ; Hydrocortisone ; Hyperpigmentation ; Hypoglycemia* ; Magnetic Resonance Imaging ; Pituitary Gland ; Potassium ; Sodium

Primary malignant lymphomas of bladder are very rare and most of them are secondary neoplasm occurring by direct extension or by metastatic spread. We report a case of malignant lymphoma showing gross involvement of bladder arising from the terminal ileum with a brief review of literature.
Ileum ; Lymphoma* ; Urinary Bladder*

Acute scrotum can occur as a complication of various procedures, such as open, laparoscopic surgeries or diagnostic procedures. We present an unusual case of acute hemiscrotum due to inadvertent gallbladder injury following an ultrasound-guided liver biopsy
Biopsy ; Biopsy, Needle ; Gallbladder ; Laparoscopy ; Liver ; Scrotum ; Testicular Hydrocele

The goal of this study was to examine the characteristics of the histo- immunological changes following induction of autoimmune prostatic inflammation achieved by subcutaneous allograft injection of the tissue homogenate of mouse ventral prostate. We also investigated the effect of the administration of androgen upon the development of mouse autoimmune prostatitis. Eight week old male C57BL/6 mice were selected and the presence, location and the degree of inflammation were identified after injection. The extent of infiltrations of the inflammatory cells in the prostate following the administration of the exogenous testosterone, the variation of the CD4/CD8 ratio of splenic lymphocyte and the variations of the interleukin-2 and tumor necrosis factor-alpha secreted by the splenic cells were also examined. The autoimmune prostatitis of the mouse induced by subcutaneous allograft injection of the mouse ventral prostate showed histological findings similar to that of human. The degree of induction was in proportion to the amount of tissues injected and showed organ-specificity. Exogenous administration of testosterone resulted in partial inhibitory effect on the induction of inflammation which was thought to be related to the decrease in the CD8+ T lymphocyte count and the functional inhibitory effect of the splenic T lymphocyte on the production of Interleukin- 2. However, tumor necrosis factor-alpha is presumed to be not closely related to the inhibitory effect of the administration of testosterone. In the future, further studies on the variation of cytokine levels and the value of sex hormones within the prostate and, moreover investigations in related to the humoral immune mechanism should be encouraged.
Allografts ; Animals ; Gonadal Steroid Hormones ; Humans ; Inflammation ; Interleukin-2 ; Lymphocyte Count ; Lymphocytes ; Male ; Mice* ; Prostate ; Prostatitis* ; Testosterone* ; Tumor Necrosis Factor-alpha

OBJECTIVE: Because of the limited penetration into the central nervous system after systemic administration of numerous therapeutic compounds, intratumoral chemotherapy for brain tumors has also been used. However, the efficacy of intratumoral drug administration is restricted by the poor diffusion of drug through tumor and brain interstitium. In order to enhance the diffusion of chemotherapeutic agent and increase the cytotoxicity with minimal dose, the authors report the results of convection-enhanced delivery(CED) of chemotherapeutic agent to the malignant brain tumor as a method of enhancing cerebral drug delivery. METHODS: Authors used "CADD-Micro(R) ambulatory infusion pump" from Deltec, which can be programmed for continuous infusion. Intratumoral injection of chemotherapeutic drug using the pump was applied to eight patients with glioma and one patient with lymphoma. Surgery was done and tumor was removed as much as possible. The tip of catheter was placed in the center of tumor cavity. Adriamycin (0.16~0.32mg) was put in the reservoir which was connected to the proximal catheter and fixed in the pump device. Twenty-four hours after surgery, Adriamycin was infused. RESULTS: There was no adverse reaction of CED technique. Compared with current delivery techniques, the improvement of survival rate has been observed(5 patients: alive, 3 patients: dead, 1 patient: lost(alive to 5 mo.)). CONCLUSION: CED can be useful method for distributing therapeutic molecules in the interstitial space of tumor and can be utilized for chemotherapeutic agents, immunotoxins, and gene etc..
Brain ; Brain Neoplasms ; Catheters ; Central Nervous System ; Diffusion ; Doxorubicin ; Drug Therapy ; Glioma ; Humans ; Immunotoxins ; Lymphoma ; Survival Rate

PURPOSE: This study aimed to examine the outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with peritoneal metastasis (PM) of advanced gastric cancer (AGC). MATERIALS AND METHODS: Between May 2015 and June 2017, 38 CRS and HIPEC procedures were performed in patients with PM of AGC at the Dankook University Hospital. We prospectively collected and analyzed data regarding PM grade, morbidity and mortality rates, and short-term follow-up results (median, 13.5 months). RESULTS: The mean peritoneal cancer index was 15 (range, 0–39). Complete cytoreduction was achieved in 21 patients (55.2%), whereas complications occurred in 16 (42.1%) and 2 (5.7%) patients died. The overall median patient survival time was 19 months. The patients who underwent complete cytoreduction had a median survival time of 26 months, which was significantly longer than the median survival time of 16 months in the patients who did not undergo complete cytoreduction (P=0.006). CONCLUSIONS: CRS with HIPEC may have a beneficial effect in patients with PM of AGC. However, the rates of complications and mortality associated with this combined therapeutic approach are high. Therefore, this treatment should be performed only in selected patients by surgeons experienced in the field of gastric cancer with PM.
Drug Therapy* ; Follow-Up Studies ; Humans ; Mortality ; Neoplasm Metastasis* ; Prospective Studies ; Stomach Neoplasms* ; Surgeons

OBJECTIVE: The aim of the study was to review the clinical and radiological findings of those non-functioning adenomas(NFAs) with positive immnoreactivity for anterior pituitary hormones. METHODS: Sixty patients with pituitary adenoma were treated at the author's institution between January 2000 and July 2005. All consecutive patients were underwent transsphenoidal surgery by same operator. In addition to the routine histopathological examination, surgical specimen was examined by immunohistochemical staining against adenohypophyseal cells. And clinical analysis was performed by retrospective review of medical records, neuroimaging examinations and immunohistochemical technique. We classified these pituitary adenomas into functioning adenomas (group F), immunopositive NFAs (group S, so-called silent adenoma) and immuno-negative NFAs (group N), and compared clinical and radiological differences between group F, N, and S. RESULTS: Of the 60 cases, group F was 25, group S was 25, and group N was 10. Among the group S, 5 cases showed reactivity against PRL, 1 against GH, 1 against both PRL and GH, 1 against TSH and GH, 2 against ACTH, 11 against FSH and 4 against both LH and FSH. Radiologically, invasiveness was noted in 8 in group S, compared to 3 in group N and 1 in group F (p=0.02). Intratumoral bleeding was noted in 7 of group S, 2 of group N and 2 of group F (p>0.05). CONCLUSION: Silent adenomas were thought to behave more aggressive than other subgroups of pituitary adenomas. And so we suggest the immunohistochemical study against adenohypophyseal cells may be helpful for evaluating clinical course of pituitary adenoma, expecially for, NFAs.
Adenoma* ; Adrenocorticotropic Hormone ; Hemorrhage ; Humans ; Immunohistochemistry ; Medical Records ; Neuroimaging ; Pituitary Gland* ; Pituitary Hormones, Anterior ; Pituitary Neoplasms ; Retrospective Studies

Purpose: To proceed effectively with clinical research requires an understanding of the fundamental principles of study design and biostatistical methods. In this article, we identified and summarized basic clinical research designs and some of the key biostatistical methods that have been commonly used in clinical research. Materials and Methods: In an observational study, cross-sectional, case- control and Cohort designs were illustrated and compared. In a clinical trial study, parallel group design and cross-over designs were described according to their characteristics. Also, the biostatistical methods for their usages classified and summarized. Results: Understanding and evaluating research design are part of the process researchers must use to determine both the quality and usefulness of their research. Adequate applications to biostatistical methods are need; i.e., descriptive statistics, Student's t-test, ANOVA, nonparametrics, categorical data analysis, correlation and regression, and survival analysis. Conclusions: Research findings are used by clinical researcher to guide their practice and reduce their uncertainty in clinical decision making. However, to understand how to interpret research results, it is important to be able to understand basic statistical concepts and types of study design. Clinicians should also appropriately choose the biostatistical methods to suit their purposes.
Biostatistics ; Cohort Studies ; Cross-Over Studies ; Decision Making ; Observational Study ; Research Design* ; Statistics as Topic ; Uncertainty

BACKGROUND AND OBJECTIVES: It is very important to distinguish between the primary and secondary genetic effects at different sites within a small genetic region. Therefore, we evaluated the relative effects of single nucleotide polymorphisms (SNPs) within a gene on the serum lipid profiles by using individual data. SUBJECTS AND METHODS: To evaluate the contributions of SNPs in a region to the serum lipid profiles (total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein), we used data that consisted of 808 individuals (327 males and 481 females) who did not have cardiovascular disease. In this study, we used a stepwise regression procedure to analyze the relative effects of four single nucleotide polymorphisms (ACE6, ACE7, ACE8, ACE10) in a gene region on the development of the serum lipid profiles in each gender group. RESULTS: In the males, there were epistatic interaction effects between two loci (ACE6xACE7, ACE6xACE8, ACE6xACE10, ACE8xACE10 and ACE7xACE8) and among three loci (ACE6xACE7xACE8, ACE6xACE7xACE10 and ACE6xACE8xACE10). Also, there are interaction effects between two loci (ACE6xACE7, ACE6xACE8, ACE6xACE10, ACE7xACE10 and ACE8xACE10) and among three loci (ACE6xACE7xACE8, ACE6xACE7xACE10, ACE6xACE8xACE10 and ACE7xACE8xACE10) in the females. CONCLUSION: The results suggested that each of these loci is important in causing a relative change of the serum lipid profiles, even with simultaneously accounting for the effects at the other loci. In the results of the analysis, there existed the effects of individual loci and significant interaction between the loci on the serum lipid profiles in each gender group. It was confirmed that this stepwise regression method can be suitable for evaluating the relative effects of SNPs and it is easily performed.
Cardiovascular Diseases ; Cholesterol ; Female ; Genes, vif* ; Humans ; Linear Models* ; Lipoproteins ; Male ; Peptidyl-Dipeptidase A ; Polymorphism, Single Nucleotide* ; Triglycerides

Nasopharyngeal teratomas are rare congenital tumors which mainly cause neonatal respiratory difficulty or feeding problems. We report an extremely rare case of nasopharyngeal teratoma in which a 34-year-old woman experienced a foreign body sensation. Simple radiographs and CT scans revealed the presence of an exophytically growing mass with a region of fatty attenuation and a well-formed tooth in the nasopharyngeal wall. The mass was surgically removed, and found at histopathology to be a mature teratoma.
Adult* ; Female ; Foreign Bodies ; Humans ; Sensation ; Teratoma* ; Tomography, X-Ray Computed ; Tooth