PURPOSE: Hemorrhagic metastatic brain tumors are not rare, but little is known about the surgical outcome following treatment. We conducted this study to determine the result of the surgical outcome of hemorrhagic metastatic brain tumors. MATERIALS AND METHODS: From July 2001 to December 2008, 21 patients underwent surgery for hemorrhagic metastatic brain tumors at our institution. 15 patients had lung cancer, 3 had hepatocellular carcinoma, and the rest had rectal cancer, renal cell carcinoma, and sarcoma. 20 patients had macroscopic hemorrhage in the tumors, and one patient had intracerebral hemorrhage surrounding the tumor. A retrospective clinical review was conducted focusing on the patterns of presenting symptoms and signs, as well as local recurrence following surgery. RESULTS: Among 21 hemorrhagic brain metastases, local recurrence developed in two patients. The 12 month progression free survival rate was 86.1%. Mean time to progression was 20.8 months and median survival time after surgery was 11.7 months. CONCLUSION: The results of our study showed that hemorrhagic metastatic brain tumors rarely recurred after surgery. Surgery should be considered as a good treatment option for hemorrhagic brain metastasis, especially in cases with increased intracranial pressure or severe neurologic deficits.
Brain ; Brain Neoplasms ; Carcinoma, Hepatocellular ; Carcinoma, Renal Cell ; Cerebral Hemorrhage ; Disease-Free Survival ; Hemorrhage ; Humans ; Intracranial Pressure ; Lung Neoplasms ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Neurologic Manifestations ; Rectal Neoplasms ; Recurrence ; Retrospective Studies ; Sarcoma

Erythema nodosum is a reactive dermatosis that occurs in response to various stimuli, such as bacterial, fungal and viral infections, drugs and malignancies. Lesions of erythema nodosum usually appear symmetrically on the extensor aspects of the legs with occasional involvement of the thighs or forearms. Unilateral or plantar involvement uncommonly occurs. A 26-year-old man presented with bilateral, painful, multiple, confluent, erythematous, firm nodules confined to the both plantar skin for 7 days. Histopathologic examination revealed fibrosis of and a lymphohistiocytic infiltrate within the septae of fat lobules, consistent with erythema nodosum. We, herein, report an unusual case of plantar erythema nodosum, which was successfully treated with nonsteroidal antiinflammatory drugs for 2 weeks.
Adult ; Erythema Nodosum* ; Erythema* ; Fibrosis ; Forearm ; Humans ; Leg ; Skin ; Skin Diseases ; Thigh

PURPOSE: This study was performed to evaluate the distribution of homeostasis model assessment of insulin resistance (HOMA-IR), a surrogate marker of insulin resistance, and its association with metabolic risk factors among Korean adolescents. METHODS: This study was based on data from Korean National Health and Nutrition Examination Survey (KNHANES) 2008~2009. Data from 2,035 adolescents (1,053 boys, 982 girls; aged 10~19 years) were analyzed. We classified all subjects into four groups, based on the quartiles of HOMA-IR, and the highest quartile group was defined as the group with insulin resistance. We performed multivariate logistic regression analysis to determine the independent risk factors for insulin resistance. RESULTS: The highest quartile values of HOMA-IR representing insulin resistance were 3.4 for boys and 3.6 for girls. Mean body mass index, waist circumference, systolic blood pressure, serum triglyceride, alanine aminotransferase (ALT), fasting glucose and insulin increased, whereas HDL cholesterol decreased with increased HOMA-IR. We found HOMA-IR has significant positive correlation with waist circumference, triglyceride, ALT level and systolic/diastolic blood pressure, while it has negative correlation with HDL-cholesterol level (p<0.005). Independent predictors (odds ratio) for insulin resistance were elevated ALT (3.53 for boys; 4.04 for girls), central obesity (3.01 for boys; 3.20 for girls), and hypertriglyceridemia (3.03 for boys; 1.94 for girls). CONCLUSION: Metabolic risk factors were strongly associated with insulin resistance, defined as highest quartile values of HOMA-IR (> or =3.4 for boys and > or =3.6 for girls). These values could be useful as a marker of insulin resistance and metabolic risk in Korean adolescents.
Adolescent ; Aged ; Alanine Transaminase ; Biomarkers ; Blood Pressure ; Body Mass Index ; Cholesterol, HDL ; Fasting ; Glucose ; Homeostasis ; Humans ; Hypertriglyceridemia ; Insulin ; Insulin Resistance ; Logistic Models ; Metabolome ; Nutrition Surveys ; Obesity, Abdominal ; Risk Factors ; Waist Circumference

PURPOSE: The aim of this study was to analyze radiological change of Kager's triangle in patients with retrocalcaneal disorders. MATERIALS AND METHODS: Areas of Kager's triangle and calcaneus were calculated with Heron's Formula. Average of area ratio (area of Kager's triangle / area of calcaneus) was calculated for comparison and analysis, according to disease activity and aging process. One-tailed Z-test was done with the average of area ratio. RESULTS: Average of area ratio (area of Kager's trianlge / area of calcaneous) tends to decrease according to aging process and disease existence. CONCLUSION: Because area of Kager's triangle in patients with retrocalcaneal disorders tends to change according to disease activity and aging process, we should consider clinical correlation between the anatomical structure of Kager's triangle and retrocalcaneal symptoms.
Aging ; Calcaneus ; Humans

The levonorgestrel-releasing intrauterine system (LNG-IUS) is used for contraception and treatment of heavy menstrual bleeding as well as endometrial hyperplasia and early endometrial carcinoma. A 48-year-old woman visited an Internal Medicine outpatient clinic due to significantly elevated CA-125 and CA-19-9 levels in a routine health examination. She had been using LNG-IUS for 3 years. Before LNG-IUS insertion, she suffered from heavy menstrual bleeding and severe dysmenorrhea. Her endometrial sampling and ultrasonographic imaging showed no evidence of endometrial carcinoma at the time of LNS-IUS insertion. After insertion, she complained of neither abnormal uterine bleeding nor dysmenorrhea. She received a routine health checkup every year and showed results within normal range until last year. To rule out pancreatic cancer due to significantly elevated CA-19-9 levels, her physician performed positron emission tomography-computed tomography, which demonstrated increased FDG uptake in the endometrial cavity. We obtained endometrial biopsy and found endometrial carcinoma in her uterus and performed radical hysterectomy with bilteral pelvic lymphadectomy. Permanent pathology confirmed endometrial carcinoma with lymph node metastasis. She received concurrent chemoradiation therapy. We emphasize the necessity of regular follow-ups with ultrasonography and assessment of serum tumor markers for the early detection of endometrial carcinoma, although rare, in women using LNG-IUS, including those without abnormal uterine bleeding.
Ambulatory Care Facilities ; Biopsy ; Biomarkers, Tumor ; Contraception ; Dysmenorrhea ; Electrons ; Endometrial Hyperplasia ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Hemorrhage ; Humans ; Hysterectomy ; Internal Medicine ; Lymph Nodes ; Middle Aged ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Pathology ; Reference Values ; Ultrasonography ; Uterine Hemorrhage ; Uterus

Onychomycosis is the invasion of the healthy nail plate by species of dermatophytes, as well as a variety of non-dermatophytes (yeasts and moulds) which may cause nail infection, particularly after tissue damage by trauma or disease. Candida albicans and C. parapilosis are the most commonly isolated yeasts from abnormal toenails. The patient was a 20-year-old woman who presented with a thickened and crumbly nail plate of the right second finger for 4 months. Initially, a tiny yellowish macule appeared under the nail plate, which gradually involved the entire nail plate, resulting in complete deformity of the nail. She was diagnosed with diabetes mellitus 4 months ago and her blood sugar level was controlled with subcutaneous insulin injections. Direct microscopic examination of the scrapings prepared with potassium hydroxide revealed fungal elements. Repeated cultures on Sabouraud dextrose agar showed cream to white colored, semi-glossy, flat colonies, which were findings consistent with C. albicans. Complete extraction of the involved nail with meticulous curettage of the nail bed was made. She has been taking 150 mg of oral fluconazole weekly since August 2003 and showed substantial improvement.
Agar ; Arthrodermataceae ; Blood Glucose ; Candida albicans* ; Candida* ; Congenital Abnormalities ; Curettage ; Diabetes Mellitus* ; Female ; Fingers ; Fluconazole ; Glucose ; Humans ; Insulin ; Nails ; Onychomycosis* ; Potassium ; Yeasts ; Young Adult

PURPOSE: In the present study, we tested whether the presence of metabolic syndrome (MetS) would worsen the features of inflammation, plasma omega 3 fatty acid levels and antioxidant potential in treated hypertensive patients. MATERIALS AND METHODS: Two groups were classified by the components of MetS: a reference group of treated hypertensive subjects: hypertension (HTN) group (n = 39) and with more than two additional MetS components: HTN with Mets group (n = 40). We further compared the parameters between HTN group and HTN with MetS group. RESULTS: The results showed that age (p < 0.001) and body mass index (BMI) (p < 0.001) were significantly different between HTN group and HTN with MetS group. Age- and BMI-adjusted total radical trapping antioxidant potential (TRAP) (p < 0.01) was significantly lower, whereas age- and BMI-adjusted CD (p < 0.05) and interleukin (IL) 6 (p < 0.05) were significantly higher in HTN with MetS group than in HTN group. Moreover, HTN with MetS group had significantly lower levels of age- and BMI-adjusted plasma phospholipid eicosapentaenoic acid (EPA) than HTN group (p < 0.05). On the other hand, the levels of age- and BMI-adjusted intracellular cell adhesion molecule-1 (ICAM-1), adiponectin and high molecular weight (HMW)-adiponectin were not significantly different between the groups. CONCLUSION: In conclusion, our results showed increased inflammatory marker, reduced antioxidant potential and EPA levels in treated hypertensive patients in the presence of MetS, suggesting the importance of changes of therapeutic lifestyle to modify the features of MetS.
Adiponectin/blood ; Age Factors ; Antihypertensive Agents/therapeutic use ; Antioxidants/*metabolism ; Body Mass Index ; Eicosapentaenoic Acid/*blood ; Female ; Humans ; Hypertension/*blood/drug therapy/*immunology ; Inflammation/*immunology ; Intercellular Adhesion Molecule-1/blood ; Interleukin-6/blood ; Male ; Metabolic Syndrome X/blood/*complications/immunology ; Middle Aged

The present study investigated the effects of interleukin (IL)-4 on dopamine (DA) neurons in the substantia nigra (SN) in vivo of lipopolysaccharide (LPS)-treated rat. Tyrosine hydroxylase immunohistochemistry showed a significant loss of nigral DA neurons at 3 and 7 day post-LPS. In parallel, IL-4 immunoreactivity was upregulated as early as 1 day, reached a peak at 3 day and remained elevated at 7 day post-LPS. IL-4 immunoreactivity was detected exclusively in microglia. IL-4 neutralizing antibody (NA) significantly increased survival of DA neurons in LPS-treated SN in vivo by inhibiting microglial activation and production of proinflammatory mediator such as IL-1β as assessed by immunihistochemical, RT-PCR and ELISA analysis, respectively. Accompanying neuroprotection are IL-4NA effects on decreased disruption of blood-brain barrier and astrocytes. The present data suggest that endogenously expressed IL-4 from reactive microglia may be involved in the neuropathological processes of degeneration of DA neurons occurring in Parkinson's disease.
Animals ; Antibodies, Neutralizing ; Astrocytes ; Blood-Brain Barrier ; Dopamine* ; Dopaminergic Neurons* ; Enzyme-Linked Immunosorbent Assay ; Immunohistochemistry ; Interleukin-4* ; Interleukins ; Lipopolysaccharides ; Microglia ; Neurons ; Neuroprotection ; Parkinson Disease ; Rats ; Substantia Nigra* ; Tyrosine 3-Monooxygenase

Objective: Atopic dermatitis (AD) is a chronic, recurrent inflammatory skin disease. Both tralokinumab and dupilumab have been recommended in the European Guideline for the treatment of adult patients with severe AD. In Korea, dupilumab has been approved for patients with moderate to severe AD, and reimbursed for those with severe AD. Since there is no clinical trial directly comparing tralokinumab and dupilumab, we conducted indirect comparison to assess the clinical usefulness in patients with AD. Methods: We selected clinical trials for indirect comparison through a systematic literature review. Individual patient data were available for the tralokinumab clinical trial, and aggregated data were available for the dupilumab clinical trial. Therefore, we employed the Matching-Adjusted Indirect Comparison (MAIC) method. The treatment efficacy was assessed based on whether patients achieved a 75% reduction on the Eczema Area and Severity Index (EASI 75) after drug administration. Results: The difference in the proportion of patients achieving EASI 75 between tralokinumab and dupilumab was 4.7% (95% CI: −7.9 to 17.3). Considering the non-inferiority margin for the EASI 75 achievement rate is −10%, tralokinumab is deemed non-inferior to dupilumab as the lower bound of the CI for the difference in the EASI 75 achievement rate between tralokinumab and dupilumab was within −10%. Conclusion We conducted a MAIC analysis comparing tralokinumab and dupilumab based on EASI 75 achievement. The findings of this study show that tralokinumab is non-inferior to dupilumab and can be implemented in Korean clinical settings with a therapeutic position comparable to dupilumab.

Unilateral femoral neck factures are common and their incidence is increasing. However, simultaneous bilateral femoral neck fractures are rare. Although cases of simultaneous bilateral femoral neck fractures have been reported, most were caused by strong muscle contractions during electroconvulsive therapy. Simultaneous bilateral femoral neck fractures caused by a simple fall are an extremely rare injury; therefore, limited literature is available, and no case has been reported in Korea. We report herein a case of simultaneous bilateral femoral neck fractures caused by a simple fall. An 83-year-old woman visited the emergency department with bilateral hip joint pain and gait disturbance, which developed 1 day after a fall. Tenderness and severe limitation in left hip joint range of motion and mild limitation in right hip joint range of motion were observed on a physical examination. A Garden type IV femoral neck fracture in the left hip joint and a Garden type I femoral neck fracture in the right hip joint were observed on plain radiography. She underwent right screw fixation and left bipolar hemiarthroplasty 2 days after admission. The patient could walk using a walker 4 weeks postoperatively. Bone union in the right femoral neck was observed at the 3 month follow-up. No specific findings were observed at the left hip hemiarthroplasty site.
Aged, 80 and over ; Electroconvulsive Therapy ; Emergency Service, Hospital ; Female ; Femoral Neck Fractures ; Femur Neck* ; Follow-Up Studies ; Gait ; Hemiarthroplasty ; Hip ; Hip Joint ; Humans ; Incidence ; Korea ; Muscle Contraction ; Physical Examination ; Radiography ; Range of Motion, Articular ; Walkers