Cystic hepatocellular carcinoma is unusal, and visualization of the cystic components within hepatic mass lesion have suggested that the lesions were metastatic tumors, primary cystic tumors such as biliary cystadenocarcinoma or cystic papillary cholangiocarcinoma. Although hepatic lesions can be well characterized by noninvasive imaging modalities, findings are often nonspecific. Even for cystic hepatic lesions a considerable diagnostic differential exists. The diagnosis of cystic hepatocellular carcinoma was difficult before the microscopic examination of the biopsy speciemen because of very rare. Then we report an unusual of cystic hepatocellular carcinoma without liver cirrhosis.
Biopsy ; Carcinoma, Hepatocellular* ; Cholangiocarcinoma ; Cystadenocarcinoma ; Diagnosis ; Liver Cirrhosis

The purpose of this study was to identify the effect of providing toothbrushing by professionals as part of oral hygiene education for the elderly. We randomly visited 12 centers in the metropolitan city and analyzed the data of 114 participants among 310 early registrants aged >65 years, who participated in the study at all 3 time points. The subjects were categorized into an experimental group (odd-numbered visits) and a control group (even-numbered visits). Oral hygiene practices were provided for both experimental and control groups, but professional toothbrushing was performed in a different manner in the experimental group. Differences in plaque index (PI) according to the subjects' general characteristics and oral health status were assessed using the t-test, and the effect of PI difference between the experimental and control groups was assessed by repeated measure two-way analysis of variance. A stepwise multiple regression analysis was used to analyze factors affecting the PI. At baseline, the mean overall PI was 61.82. In both experimental and control groups, the PI significantly reduced from the baseline (p <0.01). At 5 weeks, the experimental group showed a decrease of 27.16 points from the baseline, and the 10-week PI was similar to the 5-week PI. The control group showed a decrease of 14.87 points from the baseline, and the PI increased by 5.74 points at 10 weeks. PI-related factors were gender and self-xerostomia. The PI was lower in the female group and the group with self-xerostomia (p <0.01). It is important to select an appropriate method to educate elderly subjects on proper removal of dental plaque and to habituate correct behavior, which requires inclusion of a direct toothbrushing intervention by a specialist.
Aged* ; Dental Plaque ; Education ; Female ; Humans ; Methods ; Oral Health ; Oral Hygiene ; Specialization ; Toothbrushing*

A 17-years old woman with a combination of unilateral pheochromocytoma and an asymptomatic islet cell tumor of the pancreas is presented. The unusual coincidence of pheochromocytoma and pancreatic islet cell tumor in the patient is of interest as a possible crossover between MEN I and MEN II. It has been suggested that MEN I represents an abnormality of the APUD(amine precursor uptake and decarboxylation) cells of ectodermal origin. However, the possibility of a common progenitor cell in the neural crest for all APUD cells has been suggested by Pearse and Polak(1971). Recent clinical reports suggest that overlap between the two syndroms may occur. The overlapping of elements of the classical endocrine neoplasia should alert clinicians to the possibility of such associations in any particular patients. Since islet cell tumors may occur in association with pheochromocytomas and may be clinically silent, exploration of the pancreas during surgery for pheochromocytomas would seem to be useful.
Adenoma, Islet Cell ; Adolescent ; APUD Cells ; Ectoderm ; Female ; Humans ; Islets of Langerhans* ; Male ; Multiple Endocrine Neoplasia Type 1 ; Multiple Endocrine Neoplasia Type 2a ; Neural Crest ; Pancreas ; Pheochromocytoma* ; Pyrus ; Stem Cells

Vascular injury caused by a central venous catheter (CVC) has been reported to be a rare complication, especially delayed vascular injury due to CVC has a few cases and it can be fatal because of delayed recognition and more serious complications. A 59-year-old woman with no available medical history was admitted for treatment of ovarian cancer. For the surgery, a triple-lumen CVC was placed through the left subclavian vein. Parenteral nutrition through the CVC was used for postoperative nutritional management in the first postoperative day. On the sixth postoperative day (POD), the patient suddenly complained of dyspnea. The CT revealed bilateral pleural effusion and irregular soft tissue density and air bubble in anterior mediastinum suggesting migration of the distal portion of the CVC into the anterior mediastium. In the intensive care unit (ICU) bilateral thoracentesis and percutaneous drainage were performed. She was discharged from the ICU in 3 days later and transferred to the general ward. This case emphasizes the possibility of the delayed vascular injury related to CVC and some strategies for prevention of vascular injury.
Central Venous Catheters* ; Drainage ; Dyspnea ; Female ; Humans ; Intensive Care Units ; Mediastinitis* ; Mediastinum ; Middle Aged ; Ovarian Neoplasms ; Parenteral Nutrition ; Parenteral Nutrition, Total* ; Patients' Rooms ; Pleural Effusion ; Subclavian Vein ; Thoracentesis ; Vascular System Injuries*

OBJECTIVES: The aim of this study was to explore clinical factors or high-risk factors associated with occurrence of delirium tremens (DT) during acute alcohol withdrawal in inpatients with alcohol dependence. METHODS: This study included 164 inpatients seeking treatment for acute alcohol withdrawal in the detoxification unit. All subjects were evaluated prospectively for known risk factors for DT and their occurrence of DT. Correlations were determined between risk factors obtained at admission and development of DT. RESULTS: Among all subjects, 42 patients (25.6%) suffered from delirium tremens within seven days after admission. DT patients had more severe alcohol withdrawal symptoms, the presence of past DT, and higher levels of aspartate aminotransferas, alanine aminotransferase, gamma-glutamyl-transpeptidase, and homocysteine, compared with patients who did not suffer DTs. According to results of a multiple regression, occurrence of DT showed correlation with the following factors at admission: tremor, a past history of DT, higher homocysteine level, and nausea and vomiting. CONCLUSION: Development of DT showed correlation with symptoms of severe alcohol withdrawal, past history of DT, and higher homocysteine level. Among these, a severity of alcohol withdrawal symptoms and a history of DT are factors that can be easily evaluated on the day of admission in order to predict the potential for occurrence of DT.
Alanine Transaminase ; Alcohol Withdrawal Delirium ; Alcoholism ; Aspartic Acid ; Delirium ; Homocysteine ; Humans ; Inpatients ; Nausea ; Prospective Studies ; Risk Factors ; Substance Withdrawal Syndrome ; Tremor

BACKGROUND: The quantitative measurement of HBV DNA is useful in the follow-up of patients with chronic hepatitis B. However, the disappearance of HBV DNA, which is not always followed by HBeAg seroconversion, may not predict the outcome of the treatment. We evaluated the usefulness of HBeAg quantitation in comparison with HBV DNA quantitation. METHODS: A total number of 89 blood samples from 34 patients who were diagnosed with chronic hepatitis B were evaluated for HBeAg quantitation by the Murex HBeAg Standard and the Murex HBeAg/anti-HBe (Murex Biotech, Dartford, England). HBV DNA levels were measured by the Hybrid Capture System (Digene Corp., Beltsville, MD, USA). RESULTS: Among the total of 34 patients, the changes in the HBeAg level in 19 patients were parallel to those of the HBV DNA level in serial monitoring. In 5 patients, whose results showed discrepancy in the levels of HBeAg and DNA, the HBV DNA became undetectable earlier than did the HBeAg. Their HBeAg levels were less than 100 U/mL and were followed by HBeAg seroconversion after 1-4 months. And, in 1 patient, a progressive increase in HBeAg quantitation was not followed by HBeAg seroconversion after 8 months, even though HBV DNA was persistently undetectable. The concor-dance rate between quantitative HBeAg and HBV DNA results was 78.7%. CONCLUSIONS: This study suggests that HBeAg quantitation can be helpful in predicting seroconver-sion, especially when HBeAg is positive and HBV DNA is negative.
DNA ; Follow-Up Studies* ; Hepatitis B e Antigens* ; Hepatitis B, Chronic* ; Hepatitis, Chronic* ; Humans ; Immunoenzyme Techniques*

Angioleiomyoma (AL) is a very rare benign tumor that originates from smooth muscle cells and has thick walled vessels. It may be found throughout the body but more frequently occurs in the lower extremities and rarely develops in the head and other parts of the body. This paper presents a case report of giant AL detected in a 33-year-old woman who complained of severe anemia, menorrhagia, and palpable lower abdominal mass. The patient underwent myomectomy and was diagnosed with AL based on the pathological report of mass. The effective treatment for AL is either simple hysterectomy or angiomyomectomy depending on the patient's desire to preserve fertility and symptom.
Adult ; Anemia ; Angiomyoma* ; Female ; Fertility ; Head ; Humans ; Hysterectomy ; Immunohistochemistry ; Leiomyoma ; Lower Extremity ; Menorrhagia ; Myocytes, Smooth Muscle ; Uterus*

BACKGROUND: Many kinds of method have been tried for the management of allergic rhinitis. However, there is no completely satisfactory modality of treatment. Recent studys are reporting that laser vaporization on the inferior turbinate for the treatment of allergic rhinitis may be a valuable surgical method with safety, less morbidity and good efficasy. But, long term effects are unkown as yet. OBJECTIVES: We aimed to observe histopathologic changes of nasal mucosal membrane about 2 years after laser surgery and to investigate relationships between improvement in subjective symptoms, frequency of surgery, and histopathologic findings. MATERIALS AND METHODS: The inferior turbinates of 24 patients with perennial allergic rhinitis were vaporized by Contact ND: YAG laser. About 2 years after surgery, specimens obtained from the inferior turbinate were examined under the light microscopy. RESULTS: 1. Common findings of histopathologic change in all cases: 1) Fibrous proliferation and scar formation in the superficial layer of the submucosa. 2) Decreased number and atrophy of goblet cells, glands and vessels. 3) Complete regeneration of ciliated pseudostratified columnar epithelium. 2. Generally, grade of fibrosis in the submucosal superficial layer tend to increase as the frequency of surgery increase. but there is no relation, statistically. The higher grade of fibrosis do not induce the better subjective improvement. 3. Significant subjective improvement(Good and excellent results) was 75%. CONCLUSION: These results suggest that allergic symptoms may be inhibited by fibrous scar formation of the submucosal superficial layer and by decreased number and atrophy of overproliferation of cells leading to allergic reaction. In addition laser surgery may be a safe and effective method with good regeneration of ciliated epithelium and high rate of improvement for treatment of allergic rhinitis. However, further study is necessary to proper explanation for result that grade of fibrosis have not a relation with subjective improvement and for long term effect of the laser surgery.
Atrophy ; Cicatrix ; Epithelium ; Fibrosis ; Goblet Cells ; Humans ; Hypersensitivity ; Laser Therapy ; Lasers, Solid-State* ; Membranes ; Microscopy ; Regeneration ; Rhinitis* ; Turbinates

Tetanus is a bacterial infection by Clostridium tetani. Its neurotoxin causes spastic paralysis and autonomic dysfunction. Intrathecal infusion of baclofen has been suggested as a pertinent treatment for generalized spasm. Our case describes a patient who had a severe generalized form of tetanus, and was effectively treated with intrathecal baclofen infusion. He showed cerebral and brainstem dysfunction during baclofen infusion, which were reversed without sequelae when baclofen was discontinued.

BACKGROUND: This study was conducted to explore the effect of known risk factors, focusing on risk factors including age at menarche, age at menopause, number of children, family history of breast cancer, and age at first birth according to breast density, in consideration of interaction among East-Asian women. METHODS: Case-control study with 2,123 cases and 2,121 controls with mammographic density was conducted. Using the mammographic film, breast density was measured using Breast Imaging-Reporting and Data System. To identify the association of selected reproductive factors including age at menarche, age at menopause, number of children, family history of breast cancer, and age at first birth according to breast density, stratified analysis was conducted according to breast density groups and interaction effects was assessed. The results were presented with adjusted OR and 95% CIs. RESULTS: Significant interaction effect between age at first birth and breast density on breast cancer (P = 0.048) was observed. Women with age at first birth ≥ 28 years old showed increased breast cancer risk in extremely dense breast group (≥ 75%) (OR = 1.627, 95% CI = 1.190–2.226). However, women with fatty breast (< 50%) and heterogeneously dense breast (50%–75%) did not show an increased association. Age at menarche, age at menopause, number of children, and family history of breast cancer did not show significant interaction with breast cancer and similar risk patterns were observed. CONCLUSIONS: Age at first birth showed significant interaction with breast density on breast cancer risk. Further studies considering biologically plausable model between exposure, intermediate outcomes and breast cancer risk with prospective design need to be undertaken in East Asian women.
Asian Continental Ancestry Group ; Birth Order ; Breast Neoplasms ; Breast ; Case-Control Studies ; Child ; Female ; Humans ; Information Systems ; Menarche ; Menopause ; Prospective Studies ; Reproductive History ; Risk Factors