We have experienced a case of occult hepatocellular carcinoma metastasized to the heart in a 41 year old female. The hepatocellular carcinoma invaded the hepatic vein, grew in a snakelike fashion up the inferior vena cava and reached the right atrium. Ultrastural examination in this case confirmed the hepatocellular origin of the tumor.
Female ; Humans ; Carcinoma, Hepatocellular

To develop a survival prediction model and to use it as a therapeutic guideline a series of 66 cases with ganglio-thalamic hemorrhage accompanying intraventricular hemorrhage were analyzed retrospectively. They were classified into the benign and fatal groups according to their final outcomes. Fourteen indices obtained from the initial CT scans were final outcomes. Fourteen indices obtained from the initial CT scans were subjected to multivariate discriminant analysis. The resultant discriminant function(Z) included the amount of hematoma in the parenchyme(AH), bicaudate cerebroventricular index(BCCI) maximum fourth ventricular width(FVW), and third cerebroventricular ratio(TCR) in an order of decreasing discriminating power and was as follows: Z = -3.2639 + 0.3508 X 10(-1) X AH + 6.8816 X BCCI + 0.1139 X FVW-5.7794 X TCR. This function predicted survivability with accuracy of 84.9% when it was applied to the original subjects. The conclusion is that AH, BCCI, FVW, and TCR are the potent predictors of the survival of patients with ganglio-thalamic hemorrhage accompanying intraventricular hemorrhage.
Hematoma ; Hemorrhage* ; Humans ; Retrospective Studies ; Tomography, X-Ray Computed*

The effect of glucose-free bupivacaine were compared among thirty patients scheduled for urologic or orthopedic surgery. Different volumes of bupivacaine(2,3 and 4ml) were used for each group of patients. Patients were positioned in the supine position just after spinal tapping. The results are summarized as follows: 1) No statistical significance was found for each group of patients in age, height, and operation time. 2) The maximal height of sensory spread tended to increase as the amount of bupivacaine increased. It was T1-10 for the first group(2ml), T8-6 for the second(3ml), and T6-5 for the third(4ml). 3) The time to maximal cephalad spread of analgesia tended to increase as the amount of bupivacaine increased. It was 14 minutes for the first group, 16 minutes for the second and 19 minutes for the third. 4) The duration of analgesia by bupivacaine is considered to be slightly longer than that by tetracaine. 5) The degree of complete motor blockade at L1-2 was 80% for the first group, and 100% for the second by third group. Therefore, spinal anesthesia with glucose-free bupivacaine is considered to be satisfactory for lengthy operations of perianal or urologic procedures and lower extremity surgery.
Analgesia ; Anesthesia ; Anesthesia, Spinal* ; Bupivacaine* ; Glucose* ; Humans ; Lower Extremity ; Orthopedics ; Spinal Puncture ; Supine Position ; Tetracaine

Basal Cell Nevus Syndrome ; Carcinoma, Basal Cell ; Child ; Early Diagnosis ; Humans ; Hypertelorism ; Incisor ; Jaw ; Macrocephaly ; Odontogenic Cysts ; Orthodontic Extrusion ; Ribs

OBJECTIVE: To evaluate the possibility of cumulative blood lead and blood ZPP as surrogates of lead body burden and to investigate their association with renal function as an index of lead body burden. METHODS: The study subjects comprised 678 lead workers with past blood lead and blood ZPP data from their employment. Cumulative blood and ZPP were calculated by accumulating the every year mean value of both indices from the new employment since 1983. To assess the cumulative data of lead workers who started their lead work before 1983, the years before 1983 were simulated with the first available data from 1983. Study variables for lead body burden were tibia bone lead and DMSA chelatable lead, whereas those for current lead biomarkers were blood lead and blood ZPP. BUN and serum creatinine were selected as clinical renal biomarkers, while NAG (N-acetyl-D-glucosamine) and RBP (Retinol binding protein) were selected as early renal biomarkers. RESULTS: The association between cumulative blood lead and blood ZPP with tibia bone lead was statistically significant with determinant coefficients (r(2)) of 0.72 and 0.567, respectively, and their relationships were better explained by the curvilinear regression model. In multiple regression analysis of current lead biomarkers on the renal biomarkers after controlling for possible confounders (age, sex, job duration, smoking and drinking status), blood lead was associated only with log-transformed NAG, whereas blood ZPP was associated with 3 other renal biomarkers. On the other hand, in multiple regression analysis of biomarkers of lead body burden on renal biomarkers after controlling for possible confounders (age, sex, job duration, smoking and drinking status), cumulative blood ZPP and tibia bone lead were associated with all 4 renal function biomarkers, whereas cumulative blood lead and DMSA chelatable lead were associated with 3 renal biomarkers except BUN. CONCLUSION: Cumulative blood and ZPP were demonstrated to be good surrogates of lead burden. Furthermore, the cumulative blood ZPP was confirmed to have a better association than the cumulative blood lead.
Biological Markers* ; Body Burden* ; Creatinine ; Drinking ; Employment ; Hand ; Smoke ; Smoking ; Succimer ; Tibia

To understand the mutational patterns and mechanism of short tandem repeats (STRs), 160 familial identification positive cases were checked by PAGE & silver stain. Mutations were observed in the 7 families at 6 STR loci (4 in autosomal STR loci and 2 in Y-STR loci). Alleles of each case observed mutation were re-amplified by PCR, and cloned. Each allele was sequenced by ABI 310 sequencer. There were 6 out of 7 pedigrees in which the 'new'alleles gained or lost a single repeat unit (4 gains, 2 losses). Only one pedigree (case 5-DYS464) gains one new allele. Double step mutations event or more than were not occurred. In the 5 pedigrees (autosomal locus), there were 3 pedigrees whose 'new'alleles came from fathers, 1 from mothers, 1 from either father or mother. The ratio was 4 : 1 or 3 : 2 between fathers and mothers. The mutation of 7 STR loci, except for case 4-DYS 448 ('AGAGAT'in DYS464), occurred in the long, uninterrupted tetranucleotide repeat regions ( 'AGAT'& 'AGAC'in D12S391, 'AAAG'in ACTBP2, 'ATAG'in D19S253, 'CCTT'in DYS464 and 'CTTT'in FGA). Father's age seems not to be related to occurrence of mutation event. The features of mutation in STR loci are important in forensic application such as the definition of criteria for exclusion in kinship identification case and the interpretation of DNA profiles in identification analysis.
Alleles ; Clone Cells ; DNA ; Fathers ; Humans ; Microsatellite Repeats ; Mothers ; Pedigree ; Polymerase Chain Reaction ; Silver

OBJECTIVE: The purposes of this study were to determine the accuracy of crown and root length measurements of premolars using cone-beam computed tomography (CBCT) and to generate reference CBCT-based data on incisor, canine, and premolar lengths in patients with malocclusions. METHODS: Imaging was performed using a CBCT scanner with a 0.292-mm voxel size and 12-bit grayscale. The CBCT-based length measurements were compared with direct measurements of 94 subsequently extracted premolars without metal restorations using the paired t-test. Furthermore, the crown and root lengths of incisors, canines, and premolars in 62 Korean patients with malocclusions were measured using CBCT, and Pearson's correlation coefficients were calculated to examine the relationship between the crown and root length measurements of each tooth type. RESULTS: The differences between the CBCT-based and direct measurements of the extracted premolars were not significant, with 95% limits of agreement of -0.90 to 0.90 mm for crown length and -1.23 to 1.18 mm for root length. Weak positive correlations between the crown and root length measurements were observed for the mandibular canine and premolars. CONCLUSIONS: The CBCT-based measurements showed a wider range of limits of agreements for root length than for crown length. The CBCT-based data can be used as a reference for evaluating root length and resorption of teeth without metal restorations in patients with malocclusions.
Bicuspid* ; Cone-Beam Computed Tomography* ; Crowns* ; Humans ; Incisor* ; Malocclusion* ; Root Resorption ; Tooth

Objective: It is unknown whether artificial intelligence-based computer-aided detection (AI-CAD) can enhance the accuracy of chest radiograph (CR) interpretation in real-world clinical practice. We aimed to compare the accuracy of CR interpretation assisted by AI-CAD to that of conventional interpretation in patients who presented to the emergency department (ED) with acute respiratory symptoms using a pragmatic randomized controlled trial. Materials and Methods: Patients who underwent CRs for acute respiratory symptoms at the ED of a tertiary referral institution were randomly assigned to intervention group (with assistance from an AI-CAD for CR interpretation) or control group (without AI assistance). Using a commercial AI-CAD system (Lunit INSIGHT CXR, version 2.0.2.0; Lunit Inc.). Other clinical practices were consistent with standard procedures. Sensitivity and false-positive rates of CR interpretation by duty trainee radiologists for identifying acute thoracic diseases were the primary and secondary outcomes, respectively. The reference standards for acute thoracic disease were established based on a review of the patient’s medical record at least 30 days after the ED visit. Results: We randomly assigned 3576 participants to either the intervention group (1761 participants; mean age ± standard deviation, 65 ± 17 years; 978 males; acute thoracic disease in 472 participants) or the control group (1815 participants; 64 ± 17 years; 988 males; acute thoracic disease in 491 participants). The sensitivity (67.2% [317/472] in the intervention group vs. 66.0% [324/491] in the control group; odds ratio, 1.02 [95% confidence interval, 0.70–1.49]; P = 0.917) and false-positive rate (19.3% [249/1289] vs. 18.5% [245/1324]; odds ratio, 1.00 [95% confidence interval, 0.79–1.26]; P = 0.985) of CR interpretation by duty radiologists were not associated with the use of AI-CAD. Conclusion AI-CAD did not improve the sensitivity and false-positive rate of CR interpretation for diagnosing acute thoracic disease in patients with acute respiratory symptoms who presented to the ED.

Sodium nitrite is commercially used as a coloring agent, food preservative, and corrosion inhibitor. Accidental poisoning with sodium nitrite from contaminated food and water causes gastrointestinal irritation, vasodilatation, and methemoglobinemia with subsequent tissue hypoxia. We describe an outbreak case of sodium nitrite-induced methemoglobinemia following the ingestion of noodles contaminated with industrial antifreeze. The eEight patients involved initially complained that their noodles tasted 'unpleasant' and soon afterwards experienced nausea, vomiting, dizziness, and fatigue. Some of them noted cyanosis on their lips and fingers. Subsequent investigations demonstrated a high methemoglobin concentration which was corrected by the intravenous administration of methylene blue three hours after the onset of symptoms. The patients made a prompt, uncomplicated recovery and were discharged home 4 four days later. Industrial antifreeze contains sodium nitrite and calcium nitrite. Because an accidental poisoning of industrial antifreeze causes fatal methemoglobinemia, emergency physicians should promptly identify its symptoms and institute treatment with methylene blue promptly. In addition, industrial agencies must caution construction businesses against such contamination events.
Administration, Intravenous ; Anoxia ; Calcium ; Commerce ; Corrosion ; Cyanosis ; Dizziness ; Eating ; Emergencies ; Fatigue ; Fingers ; Humans ; Lip ; Methemoglobin ; Methemoglobinemia ; Methylene Blue ; Nausea ; Sodium ; Sodium Nitrite ; Vasodilation ; Vomiting

OBJECTIVE: This study was performed to identify the clinical characteristics on the prevalence of gestational diabetes mellitus (GDM) related to risk factors and to assess the significance of screening test. METHODS: From Jan. 2000 to Dec. 2001, 513 women attending prenatal clinic were screened for GDM. Universal screening with 50 gm GTT were performed during 24-28th gestational weeks period. Women with 1 hour plasma glucose >or=140 mg/dl underwent 100 gm GTT for diagnosis of GDM. The patients were divided into high risk and control group. RESULTS: The overall incidence of GDM was 3.1%. Among high risk group and control group, the prevalence of positive screening tests were 28.9% vs 13.6% (P=0.001), and frequencies of abnormal 100 gm GTTs were 8.8% vs 0.6% (P=0.001), respectively. These rates were statistically significant. The significant risk factors were glucosuria, family history of DM and obesity (BMI >or=25). With increasing BMI, the prevalence of GDM was found to be significantly increased. CONCLUSION: The screening test of GDM would be preferable for all pregnant women rather than risk group only. Intensified management approach is needed for patients with glucosuria, family history of DM or obesity.
Blood Glucose ; Diabetes Mellitus* ; Diabetes, Gestational ; Diagnosis ; Female ; Glucose Tolerance Test* ; Humans ; Incidence ; Mass Screening ; Obesity ; Pregnancy ; Pregnant Women ; Prevalence ; Risk Factors