Adenosquamous carcinoma in the duodenum is extremely rare disease entity and only 6 cases were reported all over the world so far. Recently we encountered a 62 year-old female patient with duodenal adenosquamous carcinoma. The patient subsequently underwent Whipple's operation. Histopathologic examination revealed two pathologic components composed of adenocarcinoma and squamous cell carcinoma. The metastatic foci of lymph nodes were composed of pure squamous cell carcinoma. For differential diagnosis, we performed several special stains including high molecular weight cytokeratin(HMWCK), low molecular weight cytokeratin(LMWCK), carcinoembryogenic antigen( CEA), mucicarmine, periodic acid-Schiff(PAS). Immunohistochemical stains demonstrated LMWCK, CEA, mucicarmine positivity for glandular component and HMWCK for squamous component. Weak positivity for squamous component was observed with PAS stain. The pathogenesis of adenosquamous carcinoma is controversial issue and not resolved yet, so we discussed the histogenesis of adenosquamous carcinoma.
Adenocarcinoma ; Carcinoma, Adenosquamous* ; Carcinoma, Squamous Cell ; Coloring Agents ; Diagnosis, Differential ; Duodenum ; Female ; Humans ; Lymph Nodes ; Middle Aged ; Molecular Weight ; Rare Diseases

No abstract available.
Drug Therapy*

Treatment of Rupture of Achilles tendon was first reported by Pare, 1575 and thereafter the various causes, diagnostic & therapeutic method of the ruptured tendon have been described by many authors. The two options of treatment are conservative management and surgical treatment and currently surgical intervention has been more popular. There are various surgical techniques which have been reported by many surgeons to treat the acute rupture of the Achilles tendon. In this report, 18 cases ( 11 male & 7 female ) of injuried Achilles tendon had been treated by the modified Lindholm method and follow-up study of 18 cases had been made during 28 months from august. 1993 to december, 1995. The results as follows; 1. After repair by the modified Lindholm method, a long leg cast was applied, and then aweight bearing was started average 8 weeks postoperatively. It can be demonstrated to shorten hospitalization and early ambulation compared to other surgical techniques 2. Postoperative power of triceps surae muscle was improved to normal in 15 patients ofthe 18 patients, and muscle power was good in 3 patients, but, all cases was improved to nearly normal whithin the last follow up. 3. Heel to floor distance was 0.6cm less on the operated side than on the normal side, and the difference decreased to 0.2cm at the last follow up. 4. The calf atrophy was minimal, and active range of motion of ankle was within normal limit. 5. We suggest that the procedure is recommended for one of the methods of the treatment of acute rupture of the Achilles tendon, because it is easy to do and permits early weight bearing and the complication is less.
Achilles Tendon* ; Ankle ; Atrophy ; Early Ambulation ; Female ; Follow-Up Studies ; Heel ; Hospitalization ; Humans ; Leg ; Male ; Range of Motion, Articular ; Rupture* ; Tendons ; Weight-Bearing

It is important to follow strict indications for surgery and recognize prognostic factors in order to get good results in the surgical treatment of herniated nucleus pulposus. 55 patients with herniated nucleus pulposus were studied who had had laminectomy and discectomy and were followed up for more than 1 year in order to analyze the correlation between various factors including history, physical examination and radiologic finding and surgical results. Age, sex, symptom duration, location of the herniation, smoking, occupation, physical examination, disc height change, MRI findings, operation time and bleeding volume were evaluated as prognostic factors that seemed to influence surgical result. The results are as follow 1. Female had significantly better surgical results than male (P<0.05). 2. Non-smokers had significantly better surgical result than smokers (P<0.01). 3. In MRI finding, protruded disc had significantly better surgical result when it had involved spinal canal posterolaterally than centrally (P<0.01). 4. The less bleeding volume, the better surgical result (P<0.05).
Diskectomy ; Female ; Hemorrhage ; Humans ; Laminectomy ; Magnetic Resonance Imaging ; Male ; Occupations ; Physical Examination ; Smoke ; Smoking ; Spinal Canal

The coagulation cascade and inflammatory process are known to be associated with the pathophysiology of acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). We retrospectively investigated laboratory values indicating coagulopathy obtained within 24 hr from diagnosis of ALI/ARDS in 79 children who received mechanical ventilation between 2008 and 2009 and their final outcomes. Prothrombin time (PT) (P = 0.001) and activated partial thromboplastin time PTT (APTT) (P = 0.001) were more prolonged in non-survivors than survivors (mean; 1.57 vs 1.33; 63 vs 57). In multivariate analysis with stratification by oxygenation-index (< 14.5, > or = 14.5), prolonged PT (> or = 1.46 international normalized ratio, [INR]) (hazard ratio; 2.043, 1.027-4.064) was associated with lower non-pulmonary-organ-failure-free survival rate (FFS), and prolonged APTT (> or = 50 seconds) (2.062, 1.031-4.121; 2.422, 1.227-4.781) was associated with lower overall survival rate (OS) and lower FFS. In stratification by ventilation-index (< 40, > or = 40), prolonged PT (2.232, 1.095-4.540; 2.177, 1.092-4.342) and prolonged APTT (2.574, 1.230-5.386; 3.089, 1.500-6.360) were associated with lower OS and lower FFS. Prolonged PT and APTT are associated with mortality in mechanically ventilated children with ALI/ARDS. We suggest PT and APTT as prognostic factors of ALI/ARDS in children.
Acute Lung Injury/*etiology/mortality ; Adolescent ; Blood Coagulation Disorders/*complications ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Male ; Multivariate Analysis ; Partial Thromboplastin Time ; Prognosis ; Prothrombin Time ; Respiratory Distress Syndrome, Adult/*etiology/mortality ; Retrospective Studies ; Survival Rate ; Young Adult

OBJECTIVE: To identify predictive factors of depressive mood in patients with isolated cerebellar stroke. METHODS: A retrospective chart review was performed in patients who had experienced their first isolated cerebellar stroke during 2002-2014. The patients were classified into two groups by the Geriatric Depression Scale (GDS) (non-depressive group, 0≤GDS≤16; depressive group, 17≤GDS≤30). Data on demographic and socioeconomic factors, comorbidities, functional level, cognitive and linguistic function, and stroke characteristics were collected. Significant variables in univariate analysis were analyzed using logistic regression. RESULTS: Fifty-two patients were enrolled, of whom 55.8% had depressive mood, were older (p=0.021), and had higher hypertension rates (p=0.014). Cognitive and linguistic functions did not differ between the two groups. The depressive group had higher ischemic stroke rates (p=0.035) and showed a dominant right posterior cerebellar hemisphere lesion (p=0.028), which was independently associated with depressive mood in the multiple logistic regression analysis (odds ratio, 5.081; 95% confidence interval, 1.261-20.479). CONCLUSION: The risk of depressive mood after cerebellar stroke was increased in patients at old age, with a history of hypertension, ischemic stroke, and lesion of the right posterior cerebellar hemisphere. The most significant determining factor was stroke lesion of the right posterior cerebellar hemisphere. Early detection of risk factors is important to prevent and manage depressive mood after cerebellar stroke.
Cerebellum ; Comorbidity ; Depression ; Humans ; Hypertension ; Linguistics ; Logistic Models ; Retrospective Studies* ; Risk Factors ; Socioeconomic Factors ; Stroke*

Traumatic brain injury can cause movement disorders such as tremor, dystonia, myoclonus, parkinsonism and chorea. After the severe traumatic brain injury, movement disorders have been reported in 13 to 66% of patients and 20% of cases combined with weakness, spasticity, cognitive impairment and ataxia. Postural/kinetic tremor, which is the most common type of movement disorder after traumatic brain injury, may be transient or persistent however the other syndromes tend to persist and produce significant impairment in activity of daily living. The symptomatic relief can generally be achieved with medical treatment and some cases with neurosurgical intervention such as functional stereotactic surgery or deep brain stimulation. This article reviews the epidemiology, underlying mechanism, the type and treatment of movement disorders follow traumatic brain injury.
Ataxia ; Brain Injuries ; Chorea ; Deep Brain Stimulation ; Dystonia ; Humans ; Movement Disorders ; Muscle Spasticity ; Myoclonus ; Parkinsonian Disorders ; Tremor

We report here a case of strongyloidiasis in a 72-year-old diabetic patient (woman) accompanied by gastrointestinal stromal tumor receiving imatinib therapy, first diagnosed as hypereosinophilic syndrome and treated with steroids for uncontrolled eosinophilia. She suffered from lower back pain and intermittent abdominal discomfort with nausea and diagnosed with gastrointestinal stromal tumor. After post-operative imatinib treatment eosinophilia persisted, so that steroid therapy was started under an impression of hypereosinophilic syndrome. In spite of 6 months steroid therapy, eosinophilia persisted. Stool examination was performed to rule out intestinal helminth infections. Rhabditoid larvae of Strongyloides stercoralis were detected and the patient was diagnosed as strongyloidiasis. This diagnosis was confirmed again by PCR. The patient was treated with albendazole for 14 days and her abdominal pain and diarrhea improved. This case highlights the need for thorough investigation, including molecular approaches, to test for strongyloidiasis before and during steroid therapies.
Aged ; Albendazole/administration & dosage ; Animals ; Diabetes Mellitus, Type 2/complications ; Eosinophilia/complications/*drug therapy ; Female ; Gastrointestinal Stromal Tumors/complications/*drug therapy ; Humans ; Imatinib Mesylate/*administration & dosage ; Steroids/*administration & dosage ; Strongyloides stercoralis/genetics/isolation & purification/physiology ; Strongyloidiasis/*drug therapy/parasitology

PURPOSE: In this retrospective study, we analyzed the outcomes of prostate cancer patients treated with the CyberKnife radiotherapy system (Accuray). MATERIALS AND METHODS: Between 2007 and 2010, 31 patients were treated for prostate cancer by use of the CyberKnife radiotherapy system. After excluding six patients who were lost to follow-up, data for the remaining 25 patients were analyzed. Patients were divided into the CyberKnife monotherapy group and a postexternal beam radiotherapy boost group. Clinicopathologic features and treatment outcomes were compared between the groups. The primary endpoint was biochemical recurrence-free survival period based on the Phoenix definition. Toxicities were evaluated by using the Radiation Therapy Oncology Group scoring criteria. RESULTS: Of 25 patients, 17 (68%) and 8 (32%) were classified in the monotherapy and boost groups, respectively. With a median follow-up of 29.3 months, most of the toxicities were grade 1 or 2 except for one patient in the boost group who experienced late grade 3 gastrointestinal toxicity. The overall biochemical recurrence rate was 20% (5/25) and the median time to biochemical recurrence was 51.9 months. None of the patients with low or intermediate risk had experienced biochemical recurrence during follow-up. Among D'Amico high-risk populations, 16.7% (1/6) in the monotherapy group and 50.0% (4/8) in the boost group experienced biochemical recurrence. CONCLUSIONS: Our data support that prostate cancer treatment by use of the CyberKnife radiotherapy system is feasible. The procedure can be a viable option for managing prostate cancer either in a monotherapy setting or as a boost after conventional radiotherapy regardless of the patient's risk stratification.
Follow-Up Studies ; Humans ; Lost to Follow-Up ; Prostate* ; Prostatic Neoplasms* ; Radiosurgery ; Radiotherapy* ; Recurrence ; Retrospective Studies

The provocation test of variant angina are known as ergonovine test, hyperventilation, acetylcholine, exercise and cold pressor test, but beta-blocker provocation test has not been reported as a case. So, this paper reports on the diagnosis of variant angina by beta-blocker provocation test and the case of subendocardial infarcion induced by this test. This study reports with literature and investigation about the following case : A 45-year-old man with a history of recurrent episode of typical angina on the early morning for the past 20 days. He was administrated beta-blocker given by oral route, and on the next morning there was chest pain as same degree as before, Holter EKG displayed ST segment elevation and ventricular tachycardia. It was confirmed focal spasm on coronary angiography, ST segment elevation on EKG, and newly developed hypokinesia on left ventriculogram and followed-up echocardiagraphy. When the chest pain is absent, EGK was normal. And we confirmed that elevation of cardiac enzyme was absent as a result of serial follow up study.
Acetylcholine ; Chest Pain ; Coronary Angiography ; Diagnosis ; Electrocardiography ; Ergonovine ; Follow-Up Studies ; Humans ; Hyperventilation ; Hypokinesia ; Infarction* ; Middle Aged ; Spasm ; Tachycardia, Ventricular