Most of the malignant tumors of the pancreas are adenocarcinomas arising from the ductal epithelium. Primary leiomyosarcoma of the pancreas, even though it is the most common sarcoma of the pancreas, is very rare. We present a case of leiomyosarcoma of the pancreas, probably primary, with metastases to the stomach, lymph nodes, and abdominal wall. A 52-year-old woman visited the hospital with vague right upper abdominal pain and weigh loss of 6 kg for 2 months. The radiological and endoscopic examination revealed that she had a large heterogeneous mass, 11 cm in size, in the pancreatic body and tail, a 4 cm-sized mass in the paraaortic area, and a 3 cm-sized polypoid mass in the stomach. Histologically, they were all similar to one another and composed of markedly pleomorphic cells. Immunohistochemical and electron microscopic studies showed definite smooth muscle differentiation of the tumor cells. Two months later, the patient underwent an excision of a new 3 cm mass in the right lower abdominal wall, showing features of well differentiated leiomyosarcoma.
Abdominal Pain ; Abdominal Wall ; Adenocarcinoma ; Epithelium ; Female ; Humans ; Leiomyosarcoma* ; Lymph Nodes ; Middle Aged ; Muscle, Smooth ; Neoplasm Metastasis ; Pancreas* ; Sarcoma ; Stomach

OBJECTIVES: Traditional nonparametric efficiency analysis was based on the relationship between the quantitative input and output measures. This study performed nonparametric efficiency analysis, which uses the results of dental hospital accreditation with quantitative output measures. METHODS: Data came from 35 hospitals between 2008 and 2010 that participated in the demonstration projects of dental hospital accreditation. The study employed two-stage double bootstrapping (TSDB) method to overcome the shortcomings and biased results of the traditional Data Envelope Analysis (DEA). Input measures included staffs, dental hygienists, other chair-side assistants, and administrative personnel, as well as dental equipment (dental chairs). Production measures were total revenues and the number of patients that visited the participating hospitals. We considered the environmental variables, which would affect the efficiency score of dental hospitals, dental hospital types, accreditation scores, and patients' satisfaction scores. RESULTS: There was a large split between the traditional DEA scores and TSDB scores. A total of 22 out of 35 hospitals had perfect efficiency in the traditional method, but none of those showed 100% efficiency in the TSDB. Overall efficiency score was the highest in the dental facility of general hospitals (71% mean efficiency), and dental teaching hospitals were the lowest (55% mean efficiency score). The factors that affected the efficiency of dental hospitals were the types of the dental hospital and the accreditation score. CONCLUSIONS: Traditional DEA scores had biased estimates and tended to be higher. The study found that organizational efforts for improving service qualities and patient safety would affect the efficiency, as well as the accreditation results.
Accreditation ; Administrative Personnel ; Bias (Epidemiology) ; Dental Equipment ; Dental Facilities ; Dental Staff ; Hospitals, General ; Hospitals, Teaching ; Humans ; Patient Safety ; Porphyrins

We report a case of 64-year-old female patient who has had factitious skin lesions for 20 years. She complained formification sense and severe itching on her face. These symptoms were improved with squeezing and bleeding. There were scuare shaped ulcerated nodule on the right cheek and white depressed scar on the left cheek. She was treated with wet dressing and occlussive dressing, and skin lesions were nearly cleared within 3 weeks, but new lesion appeared. Pimozide 2mg #1 p.o were given under the diagnosis of delusion of parasitosis from June, 1984. Her symptoms were improved without recurrence till now. Treatment with pimozide in monosymptomatic hypochondriacal syndrome is discussed.
Bandages ; Cheek ; Cicatrix ; Delusions ; Dermatitis* ; Diagnosis ; Female ; Hemorrhage ; Humans ; Middle Aged ; Pimozide* ; Pruritus ; Recurrence ; Skin ; Ulcer

No abstract available.
Intussusception*

PURPOSE: The ictal perfusion patterns of cerebellum and basal ganglia have not been systematically investigated in patients with temporal lobe epilepsy (TLE). Their ictal perfusion patterns were analyzed in relation with temporal lobe and frontal lobe hyperperfusion during TLE seizures using SPECT subtraction. MATERIALS AND METHODS: Thirty-three TLE patients had interictal and ictal SPECT, video-EEG monitoring, SPGR MRI, and SPECT subtraction with MRI co-registration. RESULTS: The vermian cerebellar hyperperfusion (CH) was observed in 26 patients (78.8%) and hemispheric CH in 25 (75.8%). Compared to the side of epileptogenic temporal lobe, there were seven ipsilateral hemispheric CH (28.0%), fifteen contralateral hemispheric CH (60.0%) and three bilateral hemispheric CH (12.0%). CH was more frequently observed in patients with additional frontal hyperperfusion (14/15, 93.3%) than in patients without frontal hyperperfusion (11/18, 61.1%). The basal ganglia hyperperfusion (BGH) was seen in 11 of the 15 patients with frontotemporal hyperperfusion (73.3%) and 11 of the 18 with temporal hyperperfusion only (61.1%). In 17 patients with unilateral BGH, contralateral CH to the BGH was observed in 14 (82.5%) and ipsilateral CH to BGH in 2 (11.8%) and bilateral CH in 1 (5.9%). CONCLUSION: The cerebellar hyperperfusion and basal ganglia hyperperfusion during seizures of TLE can be contralateral, ipsilateral or bilateral to the seizure focus. The presence of additional frontal or basal ganglia hyperperfusion was more frequently associated with contralateral hemispheric CH to their sides. However, temporal lobe hyperperfusion appears to be related with both ipsilateral and contralateral hemispheric CH.
Basal Ganglia* ; Cerebellum* ; Epilepsy, Temporal Lobe* ; Frontal Lobe ; Humans ; Magnetic Resonance Imaging ; Perfusion ; Seizures ; Temporal Lobe* ; Tomography, Emission-Computed, Single-Photon

No abstract available.
Cerebral Palsy* ; Early Diagnosis* ; Neurologic Examination*

No abstract available.
Fibroma, Desmoplastic* ; Fibula*

PURPOSE: The purpose of this study was to examine medical professionals' perception and knowledge of hospice and palliative care (HPC) and attitude toward death. METHODS: The survey was performed on 84 physicians and 172 nurses in Busan, Korea. Data were collected from April 5, 2012 to April 30, 2012. RESULTS: Regarding the purpose of HPC, the most popular perception was "To alleviate pain and accommodate comfort" among both physicians and nurses. For the need for HPC, "Terminal patients need a separate ward for emotional fluctuation" the answer chosen by both groups the most. Both groups scored low on knowledge of HPC. For pain and symptom management, physicians scored higher than nurses (physicians: 6.97+/-1.82, nurses: 5.68+/-1.93, P<0.001). CONCLUSION: Considering the survey results, we suggest development of a program to improve medical professionals' perception and knowledge of HPC and attitude toward death.
Hospice Care* ; Hospices* ; Humans ; Korea* ; Palliative Care

No abstract available.
Amniotic Fluid* ; Female ; Iron* ; Meconium* ; Staphylococcus aureus* ; Staphylococcus*

Coffin-Lowry syndrome (CLS) is a rare X-linked hereditary disorder characterized by moderate to severe mental retardation, facial dysmorphism, tapering fingers, and skeletal deformity. A 12-month-old boy was referred to our pediatric clinic for his developmental delay and seizure with fever. The boy exhibited a coarse facial appearance characterized by prominent, high-arched eyebrow, broad nose, downward palpebral fissure, high arched palate, hypodontia. The boy also showed finger tapering and puffy hand. Hypotonia, hyperextensible fingers and hypermobility of the joint were seen. Based on these findings, he was diagnosed as having Coffin-Lowry syndrome. We report a case of Coffin-Lowry syndrome with reference.
Anodontia ; Coffin-Lowry Syndrome* ; Congenital Abnormalities ; Eyebrows ; Fever ; Fingers ; Hand ; Humans ; Infant ; Intellectual Disability ; Joints ; Male ; Muscle Hypotonia ; Nose ; Palate ; Seizures