PURPOSE: Various causes may be the etiology of gynecomastia. We investigated the levels of serum estradiol (E2), testosterone (T), ratio of E2 to T (E2/T) as well as associated diseases, drugs as the cause of gynecomastia. MATERIALS AND METHODS: E2, T, E2/T in 37 patients from gynecomastia patients (GP) and 10 healthy men were measured, and the associated diseases and drugs in 68 GP were also evaluated. Ultrasound for the adrenal gland diseases, physical examination or ultrasound for the testicular pathology were performed. RESULTS: The cause of gynecomastia varied according to the age. The levels of E2, T, E2/T in control group (CG) were 35.3 3.9 pg/ml, 5.0 0.4 ng/ml, 7.1 0.5. Those in GP were 48.7 7.1 pg/ml, 4.3 0.3 ng/ml, 12.0 1.8, respectively. The difference of E2/T as well as E, T between CG and GP was not significant. Various associated diseases or drugs were found in GP. Adrenal diseases or testicular cancer were not found in GP. CONCLUSIONS: The difference of E2/T between CG and GP is not the only cause of gynecomastia. Thus, the consideration of the age as well as associated diseases or drugs will be helpful for the better understanding of high E2/T as the cause of gynecomastia
Adrenal Gland Diseases ; Estradiol ; Gynecomastia* ; Humans ; Male ; Pathology ; Physical Examination ; Testicular Neoplasms ; Testosterone ; Ultrasonography

Some patients have ascites without having liver disease, so it is important to analyze the cause of these ascites. Tuberculous peritonitis is an infectious disease characterized by lymphocyte-dominant exudative ascites. In contrast, myxedema ascites is a very rare disease characterized by a high serum/ascites albumin gradient (SAAG) with hypothyroidism. We herein report a case involving a 48-year-old woman with both diseases simultaneously. She was hospitalized because of massive ascites, generalized edema, and a puffy face. Hypothyroidism was confirmed by thyroid function tests. Her ascitic fluid had a high SAAG; no other specific findings were identified by cytology, culture, or computed tomography. Three months after initiating drug therapy for the hypothyroidism, the patient's systemic edema improved but the ascites recurred. Accordingly, diagnostic laparoscopy was performed, and tuberculous peritonitis was confirmed. As seen in this case, when myxedema ascites is associated with tuberculous peritonitis, an accurate diagnosis may be challenging.
Ascites* ; Ascitic Fluid ; Communicable Diseases ; Diagnosis ; Drug Therapy ; Edema ; Female ; Humans ; Hypothyroidism ; Laparoscopy ; Liver Diseases ; Middle Aged ; Myxedema* ; Peritonitis, Tuberculous* ; Rare Diseases ; Thyroid Function Tests

Interrupted aortic arch may be defined as a discontinuity of the aortic arch. This uncommon anomaly was first described by Steidele in 1778 and was later classified into 3 types by Celoria and Patton. We experienced the case of a 25-year-old male with an interrupted aortic arch(Type B) which was well supplied by collateral circulations. Ligation of collateral supplies and a Y-graft replacement from ascending aorta to descending thoracic aorta and left subclavian artery was done. Postoperative aortogram revealed no collateral circulations and good continuity of the aorta without narrowing of the anatomic site. During the period of 2-month follow up, the patient was able to lead a relatively active life.
Adult ; Aorta ; Aorta, Thoracic ; Collateral Circulation ; Equipment and Supplies ; Follow-Up Studies ; Humans ; Ligation ; Male ; Subclavian Artery

BACKGROUND: The incidence of drug-resistant tuberculosis has recently decreased in Korea. However, it is still one of the major obstacles in treating pulmonary tuberculosis. This study was performed to determine the prevalence and clinical characteristics associated with drug-resistance in pulmonary tuberculosis at the tertiary referral hospital in Pusan, Korea. METHODS: The medical records of 138 patients, who had been diagnosed as active pulmonary tuberculosis were retrospectively reviewed, and results of drug susceptibility from May 1997 to June 2000. The relationships among those with a history of previous tuberculosis treatment, the extent of lung involvement, the presence of cavities on the initial chest X-ray films and patterns of drug resistance were analyzed. RESULTS: The total number of patients who had drug resistance to at least one drug was 55(39.9%). Among them 34(24.6%) had resistance to isoniazid(INH) and rifampin(RFP). There was drug resistance in 20(22%) of 91 patients without previous tuberculosis therapy, and among them 9(9.9%) were multi-drug resistant. Thirty-two(74.5%) out of 47 patients with previous therapy were drug-resistant and 25(53.2%) were multidrug resistant. For all 138 patients, resistance to INH was the was the most common(34.1%), followed by RFP(26.1%) and ethambutol(EMB)(14.5%). Drug resistance to INH, RFP, PZA and streptomycin(SM) were independently assiciated with a history of previous treatment(odds ratio;9.43, 0.09, 8.93 and 21.6 respectively, p<0.01). The extent of lung involvement on the chest films was significantly associated with the drug resistance to INH and RFP(odds ratio;2.12 and 2.40 respectively, p<0.01). The prevalence of drug resistance to RFP, INH and RFP was significantly more common in patients with a cavitary lesion on the chest films by multivariate analysis(odds ratio;4.17 and 4.81 respectively, p<0.05). CONCLUSION: This study revealed that patients with a prior treatment history for pumonary tuberculosis, and the presence of a cavitary lesion on chest films had a higher prevalence of anti-tuberculosis drug resistance. A very careful clinical and microbiological examination is needed for patients with such characteristics.
Busan* ; Drug Resistance ; Humans ; Incidence ; Korea* ; Lung ; Medical Records ; Prevalence* ; Retrospective Studies ; Tertiary Care Centers ; Thorax ; Tuberculosis ; Tuberculosis, Multidrug-Resistant ; Tuberculosis, Pulmonary* ; X-Ray Film

Acute liver failure is a rapidly progressive disease of the liver associated with high morbidity and mortality without liver transplantation. Although good survival after transplantation can be achieved, due to the disparity between patients awaiting transplantation and available organs, many patients die due to progression of the disease while waiting for a liver graft. To reduce the high morbidity and mortality associated with acute liver failure, attempts have been made during the last several decades to develop a temporary liver support system, such as artificial and bioartificial livers. The artificial liver is a non-biological device mainly aimed at the removal of accumulated toxins during liver failure, and the bioartificial liver is a biological device that has bioreactors containing living hepatocytes which provide both biotransformation and synthetic liver functions. There are currently 3 artificial livers available in the market that have been actively used in the clinical field, and 11 bioartificial livers that have been developed and have undergone clinical trials. In this article, we will discuss about the 3 artificial liver devices and 5 bioartificial liver systems that are the most advanced and have been widely evaluated clinically. Also, the characteristics and the preclinical data of the first bioartificial liver system developed in Korea that is currently under clinical investigation, will be discussed.
Alginates ; Bioreactors ; Biotransformation ; Glucuronic Acid ; Hepatocytes ; Hexuronic Acids ; Humans ; Korea ; Liver ; Liver Failure ; Liver Failure, Acute ; Liver Transplantation ; Liver, Artificial ; Transplants

Inverted papilloma of the urinary tract is a rare finding, and it is almost benign in its histologic morphology and clinical behavior. Despite several published reports, the prognostic significance and potential clinical behavior of this malady remains unclear. The most commonly associated clinical symptoms are hematuria and obstruction of the urinary tract. Most inverted papillomas of urinary tract occur in the bladder and only rarely in the ureter, renal pelvis and urethra. We report here on one case of inverted papilloma in the prostatic urethra. This was diagnosed by transrectal ultrasonography and confirmed by its histology.
Hematuria ; Kidney Pelvis ; Papilloma, Inverted* ; Ultrasonography ; Ureter ; Urethra* ; Urinary Bladder ; Urinary Tract

BACKGROUND: Laminin-1 is known to have regular functions in the development and course of differentiation of the lungs. The morphogenesis and distribution of laminin-1 still remains as a mystery and its distribution and changes in the molecular structure of laminin-1 in the pathogenesis of the lung still is a subject of great controversy. In this study, experiments were done to delineate the distribution and changes in the amount of laminin-1 after inducing inflammation of the lungs by exposing experimental animals to CS gas and especially, to find compositions of laminin-1 within type II pneumocytes. MATERIALS AND METHODS: The experimental subjects of study were newborn rats and the extracted tissue from the experimental rats were viewed under light microscope and electron microscope after the sections were treated with immunohistochemical methods and immunogold reaction methods using bounded gold particles. RESULTS: 1) Lymphocytes and mononuclear phagocytes invaded the alveolar septa in the 2 day group rats after CS gas exposure and intense interstitial inflammation was seen in the 3 day group. 2) Laminin immunoreactions decreased to a moderate degree in the 2 and 3 day group rats after CS gas exposure and strong laminin immunoreactions were seen again in the 5 and 7 day group rats. 3) Gold particles in basal lamina of the lung blood-air barrier decreased and in the type I pneumocytes decreased in the 2 and 3 day group rats after CS gas exposure. 4) Gold particles were seen only on the surface of the cell membranes of type II pneumocytes of the 1 and 2 day group rats after CS gas exposure. 5) Few gold particles around the lamellar bodies and cytoplasm of type II pneumocytes in the control rat group and at 12 hours after CS gas exposure. Gold particles are seen only on the surface of type II pneumocytes of the 1 and 2 day group rats after CS gas exposure and are evenly distributed in small amounts in the cells of the 3 day group after CS gas exposure. CONCLUSION: CS gas exposure in the rats caused inflammation of lung alveolar septa and also induced a decrease in laminin-1 in basal lamina and loss of laminin-1 in the cytoplasm of type II pneumonocytes. As the inflammatory cells disappeared, an increase in the distribution of laminin-1 occurred. This reflects tissue regeneration functions of laminin-1 in the pneumocytes of rats and the distribution of laminin-1 in type II pneumocytes can be seen through the electron microscope using immunogold methods.
Animals ; Basement Membrane ; Blood-Air Barrier ; Cell Membrane ; Cytoplasm ; Humans ; Infant, Newborn ; Inflammation ; Laminin ; Lung* ; Lymphocytes ; Molecular Structure ; Morphogenesis ; Phagocytes ; Pneumocytes ; Rats* ; Regeneration

PURPOSE: We analyzed the association of lymph node ratio (LNR) wth locoregional control (LRC) in breast cancer patients with ≥10 involved axillary lymph nodes who underwent multimodality treatment. METHODS: We retrospectively analyzed 234 breast cancer patients with ≥10 involved axillary lymph nodes between 2000 and 2011. All patients received adjuvant chemotherapy and radiotherapy (RT) after radical surgery. The cutoff value of LNR was obtained using receiver operating characteristic curve analysis. The majority of patients (87.2%) received chemotherapeutic regimen including taxane. RT consisted of tangential fields to the chest wall or intact breast, delivered at a median dose of 50 Gy, and a single anterior port to the supraclavicular lymph node area, delivered at a median dose of 50 Gy. For patients who underwent breast-conserving surgery, an electron boost with a total dose of 9 to 15 Gy was delivered to the tumor bed. RESULTS: Within a median follow-up period of 73.5 months (range, 11-183 months), locoregional recurrence (LRR) occurred in 30 patients (12.8%) and the 5-year LRC rate was 88.8%. After multivariate analysis, LNR ≥0.7 was the only independent factor significantly associated with LRC (hazard ratio, 2.06; 95% confidence interval, 0.99-4.29; p=0.05). CONCLUSION: An aggressive multimodal treatment approach showed favorable locoregional outcome in patients with ≥10 involved axillary lymph nodes. However, patients with a high LNR ≥0.7 still had an increased risk for LRR, even in the setting of current local treatments.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy, Segmental ; Multivariate Analysis ; Radiotherapy ; Recurrence* ; Retrospective Studies ; Risk Factors* ; ROC Curve ; Thoracic Wall

PURPOSE: Reduction malarplasty is a popular aesthetic surgery for contouring wide and prominent zygoma. However a few patients complain postoperative results and want to revise the midfacial contour. We analyzed the etiology of unfavorable results and treated unsatisfied midfacial contours after reduction malarplasty. METHODS: Total 53 patients were performed secondary operation for correction of unfavorable results after primary reduction malarplasty from elsewhere. Midfacial contour was evaluated with plain films and three- dimensional computed tomography. Unfavorable midfacial contours were corrected by secondary malarplasty. Flaring of zygomatic arch was reduced with infracturing technique and prominent zygomatic body was reduced with shaving. Drooped or displaced zygoma complex has been suspended to higher position and fixed with interosseous wiring. As adjuvant procedure, autologous fat injection has been performed in the region of depressed zygomatic body region. RESULTS: The etiology of unfavorable midfacial contour after reduction malarplasty was classified into 7 categories: undercorrection of zygomatic arch(n=8), undercorrection of zygomatic arch and undercorrection of zygomatic body(n=6), undercorrection of zygomatic arch and overcorrection of zygomatic body(n=28), overcorrection of zygomatic body(n=3), simple asymmetry(n=4), malunion(n=2) or nonunion(n=2). Slim and balanced malar contour was achieved with treatment. And most of the patients were satisfied with the results of the surgery. CONCLUSION: To prevent the unfavorable results after reduction malarplasty, complete analysis of facial contour, choice of appropriate operation technique, precise osteotomy under direct vision, and security of zygoma position are important.
Body Regions ; Humans ; Osteotomy ; Vision, Ocular ; Zygoma

OBJECTIVE: The authors conducted a retrospective cohort study to determine prognostic factors and treatment outcomes of brain metastases (BM) from breast cancer (BC) after Gamma Knife radiosurgery (GKS). METHODS: Pathologic and clinical features, and outcomes were analyzed in a cohort of 62 patients with BM from BC treated by GKS. The Kaplan-Meier method, the log-rank test, and Cox's proportional hazards model were used to assess prognostic factors. RESULTS: Median survival after GKS was 73.0 weeks (95% confidence interval, 46.0-100.1). HER2+ [hazard ratio (HR) 0.441; p=0.045], Karnofsky performance scale (KPS) > or =70 (RR 0.416; p=0.050) and systemic chemotherapy after GKS (RR 0.282; p=0.001) were found to be a favorable prognostic factor of overall survival. Actuarial local control (LC) rate were 89.5+/-4.5% and 70.5+/-6.9% at 6 and 12 months after GKS, respectively. No prognostic factors were found to affect LC rate. Uni- and multivariate analysis revealed that the distant control (DC) rate was higher in patients with; a small number (< or =3) of metastasis (HR 0.300; p=0.045), no known extracranial metastasis (p=0.013, log-rank test), or the HER2+ subtype (HR 0.267; p=0.027). Additional whole brain radiation therapy and metastasis volume were not found to be significantly associated with LC, DC, or overall survival. CONCLUSION: The treatment outcomes of patients with newly diagnosed BM from BC treated with GKS could be affected primarily by intrinsic subtype, KPS, and systemic chemotherapy. Therapeutic strategy and prognosis scoring system should be individualized based on considerations of intrinsic subtype in addition to traditionally known parameters related to stereotactic radiosurgery.
Brain* ; Breast Neoplasms* ; Breast* ; Cohort Studies ; Drug Therapy ; Humans ; Methods ; Multivariate Analysis ; Neoplasm Metastasis* ; Prognosis ; Proportional Hazards Models ; Radiosurgery* ; Retrospective Studies