Bone metastasis of hepatocellular carcinoma appears to be peculiar when clinical manifestation of liver disease is not apparent, and initial diagnosis of metastatic hepatocellular carcinoma by fine needle aspiration cytology is rarely obtained. We experienced a case of 45-year-old man with metastatic hepatocellular carcinoma in the sacrum, which was diagnosed by fine needle aspiration cytology. The intrahepatic mass, measuring 1.2cm in diameter and kept unchanged in size for two years, was never proved to be hepatocellular carcinoma histopathologically. The aspirated neoplastic cells were mostly in sheets, showing abundant acidophilic cytoplasm and large, round, centrally located nuclei with single, prominent acidophilic mucleoli. In the cell block section, diagnosis of metastatic well-differentiated hepatocellular carcinoma was made without difficulty, and definite trabecular fashion with sinusoidal endothelial cell lining was found.
Biopsy, Fine-Needle ; Carcinoma, Hepatocellular ; Cytoplasm ; Diagnosis ; Endothelial Cells ; Humans ; Korea* ; Liver Diseases ; Middle Aged ; Neoplasm Metastasis ; Prevalence* ; Sacrum

Rapid progress in the development of communication devices has enabled us to use various and tremendous medical information regardless of time or place. Today, in Korea there are many homepages on the web which provide medical information, hospital information, and counseling on medical fields, but more detailed recent medical information, better quality control, and a greater variety of communication skills are needed. We analysed the data about breast cancer clinic on web from November 1998 to October 1999. The frequent questions were breast mass44%, breast pan 29%, and counseling on breast cancer 25%. The most frequent users were in their 3rd decades 55%, 4th decades 8%, and unknown cases 23%. The average number of visitors on wed was 454 per month. In near future, we believe that the use of the web as a information source will grow rapidly and we everyone will use internet in Korea. So, we should realize the virtual space is a reality, and we should use it as a proper education system for the people.
Breast Diseases* ; Breast Neoplasms ; Breast* ; Counseling* ; Education ; Internet* ; Korea ; Quality Control

PURPOSE: Exercise is frequently recommended in the management of diabetes mellitus(DM) and can improve blood control by increasing insulin sensitivity and psychological benefits. Exercise can result in good glycemic control in type 2 DM, when combined with diet and drug therapy. However, in type 1 DM, the expected improvement in glycemic control with exercise have not been clearly established. Effects of exercise on glycemic control in patients with type 1 DM were investigated. METHODS: 20 patients with of type 1 DM, who were no retinopathy, neuropathy, nephropathy and cardiac disorders, were enrolled and exercised for 30min. with 50% of individualized maximum VO2. Blood sugar concentration were measured before, immediate and 15min after exercise. The results were evaluated with HbA1c, C-peptide and DM duration. RESULTS: Blood sugar concentration were significantly decreased from pre-exercise 198+/-9.7mg/dL to immediate 145+/-7.1mg/dL and at 15min. Post-exercise 134+/-4.0mg/dL(P<0.05). In case with HbA1c<10%, there was significantly decreased in blood sugar level from pre-exercise 176+/-9.7mg/dL to immediate 123+/-63.2mg/dL and at 15min post-exercise 113+/-1.9mg/dL(P<0.05). In case with HbA1c>10% there was also significantly decreased in blood sugar levels 222+/-64.7mg/dL, 169+/-6.1mg/dL, 157+/-1.2mg/dL respectively(P<0.05). Group with moderate decreased blood sugar(40-99mg/dL) was 8 patients(42.1%), group with mild decreased blood sugar(<40mg/dL) was 7 patients(36.8%) and group with decreased more than 100mg/dL was 4 patients(21.5%). There was no correlation in degree of decreased blood sugar concentration among HbA1c, C-peptide, DM duration. CONCLUSION: Proper exercise in type 1 diabetic children can decrease blood sugar level significantly and make good glycemic control and can decrease DM microvascular complications in addition to motivating physically active lifestyle.
Blood Glucose ; C-Peptide ; Child ; Diabetes Mellitus ; Diabetes Mellitus, Type 1* ; Diet ; Drug Therapy ; Humans ; Insulin Resistance ; Life Style

Inverted papilloma of the urinary bladder is a rare urothelial neoplasm, almost benign in its histologic morphology and clinical behavior. It occurs mainly in males and in the region of the trigone of bladder, or posterior urethra. But, it may arise in the renal pelvis. The characteristic downward proliferation of urothelial cells within the underlying lamina propria is of such magnitude as to an exophytic papillomatous tumor. The lesion may be easily mistaken for a low- grade papillary transitional cell carcinoma, although the histologic appearance is distinctly different, as is its subsequent behavior. Because of distinctive histologic features and patterns of growth it is possible to differentiate between two basic types of inverted papillomatous which were termed "trabecular" and "glandular". The trabecular type consists of widely branched, anastomosing cords of urothelial cells originating directly from the overlying transitional epithelium. The glandular type develops apparently from a proliferative cystitis cystica and glandularis which, therefore, should be considered a potentially preneoplastic lesion. The malignant tendency is now being reported with inverted papillomas of urinary tract and therefore they are no longer regarded as innocuous benign neoplasms. We report the 3 cases of inverted papilloma of the urinary bladder with a brief review of literature.
Carcinoma, Transitional Cell ; Cystitis ; Epithelium ; Humans ; Kidney Pelvis ; Male ; Mucous Membrane ; Papilloma, Inverted* ; Urethra ; Urinary Bladder* ; Urinary Tract

No abstract available.
Ebstein Anomaly*

PURPOSE: We investigated the clinical characteristics of IDDM patients, treated with NPH only, and evaluated current problems by measurement of serial blood glucose, insulin, C-peptide for 12 hours after administration of intermediate-acting insulin. METHODS: We studied 19 IDDM patients who had been diagnosed and followed up on a regular basis at Severance hospital. They were assigned into 2 groups, one(HbA1c high group) with HbA1c above 12%, the other(HbA1c low group) showing HbA1c below 12%. Their Heights, DM durations, HbA1c, basal C-peptides were primarily measured. Using continuous withdrawal pump, samples were taken every hour for 12 hours from 7:00 am. And serial blood glucose, insulin, C-peptide were assayed. RESULTS: 1) The mean HbA1c of the high group was 16.5+/-3.5% and that of the low group was 11.0+/-0.6%. There were no differences in clinical characteristics. 2) In HbA1c high group, fasting blood glucose, and mean blood glucose levels for 3hours were 156+/-85mg%, 284+/-125mg%(8,9,10am), 250+/-133mg% 11,12am,1pm), 252+/-122mg%(2,3,4pm), and 182+/-105 mg%(5,6,7pm), respectively. In low group, fasting blood glucose, and mean blood glucose levels for 3hours were 130+/-71mg%, 275+/-109 mg%(8,9,10am), 249+/-129mg%(11,12am,1pm), 231+/-81mg%(2,3,4pm), 158+/-62mg%(5,6,7pm), respectively. 3) Fasting blood insulin level was 51+/-47 U/l in high group, 62+/-62 U/l in low group. Thereafter low HbA1c group showed higher insulin levels than high HbA1c group. 4) Fasting blood C-peptide was 0.16+/-0.20 g/l in the high group, and 0.34+/-0.14 g/l in low group. Thereafter low group developed higher C-peptide responses than high group. The curve of C-peptide showed similar change of blood glucose, and maximal response followed 1-2 hours after maximal level of blood glucose. CONCLUSIONS: We concluded that short-acting insulin should be included for good control of blood glucose. Although fasting & dinner blood sugar seemed to be under fair control, intermediate-acting insulin used alone was not effective in preventing severe blood sugar elevation after morning meal.
Blood Glucose* ; Breakfast ; C-Peptide ; Diabetes Mellitus, Type 1* ; Fasting ; Humans ; Insulin* ; Insulin, Short-Acting ; Meals

PURPOSE: To evaluate the diagnostic value of magnetic resonance(MR) imaging in the differentiation of benign and malignant soft tissue masses. MATERIALS AND METHODS: MR examination of 47 patients with pathologically proven soft tissue masses were reviewed. This series included 19 malignant and 28 benign masses of upper and lower extremities, body, and neck. Lesions were evaluated for their margin, signal intensity and homogeneity, pattern and degree of enhancement, involvement of the adjacent tissue, and degree of surrounding edema. RESULTS: Sixteen of benign lesions(57.1%) had well-defined and smooth margin. The tumor margin was irregular in nine lesions(47.4%), however, smooth margin was noted in five cases(26.3%) of malignant lesions. On T2-weighted images, signal inhomogeneity was noted in 84% of malignant lesions and 32% of benign lesions. On Gd-DTPA enhancement study, all malignant lesions(n=18) showed enhancement and 89% showed heterogeneously enhancing pattern. Neurovascular involvement was observed more often in malignancy(n=7) compared to benign lesion(n=1). Direct invasion of the adjacent bone was noted only in malignant lesions(n=3). Surrounding edema was revealed in two benign and 11 malignant lesions. CONCLUSION: MR imaging appears useful for differentiating malignant and benign lesions by identifying tumor margin, signal homogeneity of tumor, pattern and degree of enhancement, involvement of adjacent tissue, and surrounding edema. The nature of the lesion can be determined in the majority of cases although no unique criterion to differentiate benignancy and malignancy is identified.
Edema ; Gadolinium DTPA ; Humans ; Lower Extremity ; Magnetic Resonance Imaging* ; Neck

PURPOSE: Results of 181 percutaneous needle aspiration biopsies performed with an 18-gauge needle during a period of 3 years were analyzed to determine efficacy and safety of the procedure. MATERIALS AND METHODS: Biposies were performed in patients that could not be diagnosed by bronchoscopy or sputum cytology. The biopsy procedure with 18-gauge Crown needle was guided by fiuoroscopy. The biopsy specimen placed in 10% formalin solution were histologically confirmed. RESULTS: In 160 patients(89%), the positive diagnosis was made by percutaneous needle aspiration biopsy. There were 153 lung lesions(120 malignant and 33 benign lesions) and 7 mediastinal lesions. the diagnostic accuracy of malignant and benign disease was 91% and 80% respectively. Complications included pneumothorax(n=11) and hemothorax(n=l):six of them required treatment with chest tube and the remainder showed spontaneous resporption. CONCLUSION: PCNB with an 18-gauge needle provided a reliable, relatively safe diagnostic tool to establish the diagnosis of both malignant and benign chest lesions.
Biopsy ; Biopsy, Needle* ; Bronchoscopy ; Chest Tubes ; Crowns ; Diagnosis ; Formaldehyde ; Humans ; Lung ; Needles* ; Sputum ; Thorax*

PURPOSE: Results of 181 percutaneous needle aspiration biopsies performed with an 18-gauge needle during a period of 3 years were analyzed to determine efficacy and safety of the procedure. MATERIALS AND METHODS: Biposies were performed in patients that could not be diagnosed by bronchoscopy or sputum cytology. The biopsy procedure with 18-gauge Crown needle was guided by fiuoroscopy. The biopsy specimen placed in 10% formalin solution were histologically confirmed. RESULTS: In 160 patients(89%), the positive diagnosis was made by percutaneous needle aspiration biopsy. There were 153 lung lesions(120 malignant and 33 benign lesions) and 7 mediastinal lesions. the diagnostic accuracy of malignant and benign disease was 91% and 80% respectively. Complications included pneumothorax(n=11) and hemothorax(n=l):six of them required treatment with chest tube and the remainder showed spontaneous resporption. CONCLUSION: PCNB with an 18-gauge needle provided a reliable, relatively safe diagnostic tool to establish the diagnosis of both malignant and benign chest lesions.
Biopsy ; Biopsy, Needle* ; Bronchoscopy ; Chest Tubes ; Crowns ; Diagnosis ; Formaldehyde ; Humans ; Lung ; Needles* ; Sputum ; Thorax*

Endobronchial metastasis from extrapulmonary carcinoma, both clinically and radiologically similar in appearance to a primary lung cancer, is rare. We present a case of endobronchial metastasis from parosteal osteosarcoma. The first abnormality noted on the chest radiography was tramline calcification with branching pattern along the right upper lobe bronchus and intermediate bronchus. This lesion progressed into a solid calcified nodule which increased in size. Another lesion with same pattern was also observed in the left lower lung zone.
Bronchi ; Lung ; Lung Neoplasms ; Neoplasm Metastasis ; Osteosarcoma* ; Radiography ; Thorax