Small cell carcinoma of the gallbladder is a type of neuroendocrine tumor and very rare. We report ultrasound, CT and MR findings of a small cell carcinoma of the gallbladder that was confirmed by pathology. Small cell carcinoma of the gallbladder was seen as a well-defined mass with peripheral rim enhancement in the gallbladder. In spite of the large size of the mass, direct and extensive invasion of the liver was not detected. However, there were many metastatic lymph nodes.
Carcinoma, Small Cell ; Gallbladder ; Liver ; Lymph Nodes ; Neuroendocrine Tumors

OBJECTIVE: 5-HTTLPR (5-HT transporter-linked polymorphic region), located in the promoter region of 5-HT transporter gene, was reported to be associated with several neuropsychiatric illnesses. In this study, we investigated the genotype distribution and allele frequency of serotonin transporter gene 5-HTTLPR in schizophrenic patients and normal controls using an independent Korean sample. METHODS: Subjects were 156 schizophrenic patients fulfilling the DSM-IV criteria for schizophrenia who had taken antipsychotics for at least 6 months and 96 normal controls who had no past and family history of psychiatric illnesses. Two negative symptoms of PANSS, blunted affect and emotional withdrawal, were rated in all patients by two experienced psychiatrists. We examined the genotype distribution and allele frequency of the serotonin transporter gene 5-HTTLPR in all subjects, using polymerase chain reaction (PCR) of genomic DNA with primers flanking the promoter regions of the 5-HTT gene. Between-group comparisons of the genotype distribution and allele frequency were performed by using score test for trend, Fisher's exact test, and chi-square test. RESULTS: There was no significant difference in 5-HTTLPR genotype distribution and allele frequency between schizophrenic patients and normal controls. There was also no significant difference in 5-HTTLPR genotype distribution and allele frequency between schizophrenic patients with and without the two negative symptoms, blunted affect or emotional withdrawal, respectively. CONCLUSION: These results suggest that 5-HTTLPR polymorphism had no significant association with schizophrenia and negative symptoms in a Korean sample.
Antipsychotic Agents ; Diagnostic and Statistical Manual of Mental Disorders ; DNA ; Gene Frequency ; Genotype ; Humans ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Promoter Regions, Genetic ; Psychiatry ; Schizophrenia* ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

Primary pulmonary meningioma is an extremely rare disease. It is mostly benign and asymptomatic. This tumor shows the same cytohigstologic appearance as brain or spinal cord meninioma. It can be diagnosed as a primary pulmonary meningioma only if there is no evidence of metastasis from the brain or spinal cord meningioma. We experienced a case of primary pulmonary meningioma in a 60-year-old woman who had asymptomatic 2 cm-sized solitary pulmonary tumor in the right lower lobe. It is rather peripherally located. Fine needle aspiration cytology has suggested the possibility of either well-differentiated epithelial malignancy such as papillary adenocarcinoma or mucoepidermoid carcinoma or metastatic carcinoma such as from ductal carcinoma of the breast. Right lower lobectomy was performed. The tumor was bilobated and soild with yellowish color. pathologically it proved to be a primary pulmonary and solid with yellowish color. Pathologically it proved to be a primary pulmonary meningioma because there was no evidance of brain or spinal cord tumor. To the best of our knowledge this is the first case reported in Korea. We report this case with review of the literature.
Adenocarcinoma, Papillary ; Biopsy, Fine-Needle ; Brain ; Breast ; Carcinoma, Ductal ; Carcinoma, Mucoepidermoid ; Female ; Humans ; Korea ; Meningioma* ; Middle Aged ; Neoplasm Metastasis ; Rare Diseases ; Spinal Cord ; Spinal Cord Neoplasms

Neuromyelitis optica (NMO) is an idiopathic inflammatory demyelinating disease, characterized by optic neuritis and myelitis. NMO is a very uncommon and serious neurologic manifestation of systemic lupus erythematous (SLE). We report a 28-year-old man with NMO as neuropsychiatric manifestation of SLE. He was diagnosed as lupus nephritis at 16-year-old. He had optic neuritis at three years and seven months ago. Oral prednisolone was tapered off according to the improved eye symptoms. Two months later, he visited rheumatology clinics for urinary disturbance and paresthesia on both feet. A spinal magnetic resonance imaging revealed increased signal intensity in T2-weighted images from second to sixth cervical level and from eleventh to twelfth thoracic level. We diagnosed neuromyelitis optica and treated with intravenous cyclophosphamide therapy monthly for three times. He was discharged without any neurological deficits and has been followed up.
Adolescent ; Adult ; Cyclophosphamide ; Demyelinating Diseases ; Foot ; Humans ; Lupus Nephritis ; Magnetic Resonance Imaging ; Myelitis ; Neurologic Manifestations ; Neuromyelitis Optica* ; Optic Neuritis ; Paresthesia ; Prednisolone ; Rheumatology

Hypoplasia of the internal carotid artery is a rare congenital anomaly. Agenesis, aplasia, and hypoplasia of the internal carotid artery (ICA) are frequently associated with cerebral aneurysms in the circle of Willis. Authors report two cases with congenital hypoplasia of the ICA accompanying with the aneurysms. Transfemoral cerebral angiography (TFCA) in one patient identified nonvisualization of the left ICA. Bilateral anterior cerebral artery (ACA) and middle cerebral artery (MCA) were supplied from the right ICA accompanying with two aneurysms at anterior communicating artery (AcoA) and A1 portion of the left ACA. TFCA in another patient demonstrated hypoplastic left ICA and left ACA filled from the right ICA accompanying with AcoA aneurysm. Left MCA was filled from basilar artery via posterior communicating artery (PcoA). Skull base computed tomography (CT) in two patients showed hypoplastic carotid canal. Authors performed direct aneurysmal neck clipping. Follow up CT angiography (CTA) at one year after surgery did not show regrowth or new development of the aneurysm. In patients with hypoplastic ICA, neurosurgeons should be aware of the possibility of development of the aneurysms, presumably because of hemodynamic process. Direct aneurysmal neck clipping is a good treatment modality. After operation, regular CTA, magnetic resonance angiography (MRA) or TFCA is needed to find progressive lesion and to prevent cerebrovascular attack (CVA).
Aneurysm ; Angiography ; Anterior Cerebral Artery ; Arteries ; Basilar Artery ; Carotid Artery, Internal* ; Cerebral Angiography ; Circle of Willis ; Follow-Up Studies ; Hemodynamics ; Humans ; Intracranial Aneurysm ; Magnetic Resonance Angiography ; Middle Cerebral Artery ; Neck ; Skull Base

BACKGROUND: Apolipoprotein E has been one of the most thoroughly studied genetic polymorphisms, particularly for its effects on lipid profiles and coronary heart disease risk. This study investigated the relationship between the apolipoprotein E polymorphism and essential hypertension in a Korean population. METHODS: The subjects (n=1,243) were participants in a population-based study in Incheon metropolitan City, Korea. The apolipoprotein E polymorphism was determined using a polymerase chain reaction method. RESULTS: The frequencies of the genotypes did not differ significantly between the hypertensive groups (60.0% epsilon2/epsilon2, 30.8% epsilon2/epsilon3, 44.4% epsilon2/epsilon4, 33.3% epsilon3/epsilon3, 32.3% epsilon3/epsilon4, and 15.4% epsilon4/epsilon4; p=0.498). After adjusting for other risk factors, genotypes were not associated with hypertension(OR 5.74, 95% CI 0.81-40.76, epsilon2/epsilon2 vs. epsilon3/epsilon3; OR 0.94, 95% CI 0.60-1.47, epsilon2/epsilon3 vs. epsilon3/epsilon3; OR 1.21, 95% CI 0.30-4.89, epsilon2/epsilon4 vs. epsilon3/epsilon3; OR 0.79, 95% CI 0.56-1.13, epsilon3/epsilon4 vs. epsilon3/epsilon3; OR 0.29, 95% CI 0.06-1.45, epsilon4/epsilon4 vs. epsilon3/epsilon3). CONCLUSIONS: These findings suggest that the apolipoprotein E polymorphism is not associated with hypertension.
Adult* ; Apolipoproteins* ; Coronary Disease ; Genotype ; Humans ; Hypertension* ; Incheon ; Korea ; Polymerase Chain Reaction ; Polymorphism, Genetic ; Risk Factors

OBJECTIVE: Unilateral facet dislocation of the cervical spine occurs by flexion and rotation injuries and cannot be easily reduced by axial traction. We analyzed 14 consecutive patients with unilateral facet dislocation of the cervical spine to increase knowledge about anatomical reduction of locked facet and factors for successful reduction. METHODS: Fourteen patients (10 men and 4 women) with unilateral facet dislocation of the cervical spine were retrospectively analyzed. Plain X-ray, computerized tomography scan, and magnetic resonance imaging were performed. All patients underwent manual reduction and surgery with anterior interbody fusion and plate fixation. The manual reduction was performed by neck flexion and rotation to the opposite side of dislocation, followed by rotation and flexion of the head toward the side of dislocation and extension with relaxation of traction. Mean follow-up period was 17 months. The level of spine, amount of subluxation, combined facet fracture, and time from injury to initial reduction were analyzed using the data obtained from medical records. RESULTS: Thirteen (93%) patients were reduced successfully. Immediate reduction was achieved in 7 patients but failed in 7 patients. Seven patients underwent delayed closed reduction under general anesthesia, and successful reduction was achieved in 6 patients. Only one patient with bone chips between articular facets failed to achieve anatomical reduction. CONCLUSION: In order to reduce the locked facet more easily and safely, we recommend manipulative traction with anterior interbody fusion and plate fixation under general anesthesia after being aware of spinal cord injury with magnetic resonance imaging.
Anesthesia, General ; Dislocations* ; Follow-Up Studies ; Head ; Humans ; Magnetic Resonance Imaging ; Male ; Medical Records ; Neck ; Relaxation ; Retrospective Studies ; Spinal Cord Injuries ; Spine* ; Traction

Background: and Purpose: Rapid population aging and an increase in the demented elderly became major social concerns in South Korea. Environmental design is increasingly recognized as an important aid for long-term care of patients with dementia as well as pharmacotherapy. We did a pilot study to investigate the effect of the Seoul Dementia Healing Design Project In-House Design (S-DHDP-IHD) in improving the quality of life of the cognitively impaired patients and of the S-DHDP Environmental Design (S-DHDP-ED) in increasing daily outdoor activities for cognitively impaired individuals and not cognitively impaired (NCI) elderly residents. Methods: We applied the S-DHDP-IHD to 2 households of patients with mild cognitive impairment (MCI) and early-stage vascular dementia (VD). We assessed the effectiveness of intervention by surveys and video recordings of daily tasks. Additionally, we applied the S-DHDP-ED to 5 community facilities and randomly selected 287 residents over 65 years old (32 dementia caregivers and 255 NCI elderly) to participate in surveys. Results: S-DHDP-IHD intervention showed improved instrumental activities in MCI patient and early-stage VD patient. Also, the satisfaction with an intervened home environment was increased. Following S-DHDP-ED intervention, non-demented residents engaged in more outdoor and social activities. They were also satisfied with the function and design of the installed facilities. Conclusions S-DHDP encompassing both home and environmental improvements was effective in readapting cognitively impaired individuals and could achieve a customized, holistic approach to dementia caregiving by means of the improved design.

BACKGROUND/AIMS: In the Helicobacter pylori (H. Pylori)-negative normal stomach, collecting venules are visible over all the gastric body as numerous minute points evaluated with standard endoscopy. This finding was termed regular arrangement of collecting venules (RAC), and its absence suggests H. Pylori gastritis. The aim of this study was to evaluate the correlation between the RAC and rapid urease test. METHODS: Two hundred sixty three consecutive adults undergoing upper digestive endoscopy and rapid urease test were included. The lesser curvature of the lower corpus was evaluated for the RAC pattern using a standard endoscope and different hemoglobin index. Two biopsies from the lesser curvature of the antrum and the greater curvature of the body were collected for rapid urease test. RESULTS: H. Pylori were detected in 51.3% (135/263) patients. Of the 57 patients with H. Pylori-negative normal stomachs 53 patients (93%) had RAC. As a determinant of the normal stomach without H. Pylori infection, the presence of RAC had 41.4% sensitivity, 97.0% specificity, 93.0% positive predictive value and 63.6% negative predictive value. CONCLUSIONS: RAC-positive finding by standard endoscopy showed high positive predictive value and specificity of H. Pylori-negative normal stomach. RAC-positive finding by standard endoscopy could be an useful finding to predict H. Pylori negativity.
Adult ; Aged ; Diagnosis, Differential ; Endoscopy, Gastrointestinal ; Female ; Gastritis/microbiology/pathology ; Gastroscopy ; Helicobacter Infections/*diagnosis/microbiology ; *Helicobacter pylori ; Hemoglobins ; Humans ; Male ; Middle Aged ; Pyloric Antrum/blood supply/microbiology/pathology ; Retrospective Studies ; Sensitivity and Specificity ; Urease/metabolism ; Venules/anatomy & histology

BACKGROUND/AIMS: Hepatitis-B-related acute-on-chronic liver failure has a poor prognosis. However, the advent of potent oral antiviral agents means that some patients can now recover with medical treatment. We aimed to identify the prognostic factors for hepatitis-B-related acute-on-chronic liver failure including the initial as well as the dynamically changing clinical parameters during admission. METHODS: Sixty-seven patients were retrospectively enrolled from 2003 to 2012 at Samsung Medical Center. The patients were classified into three categories: Recovery group (n=23), Liver transplantation group (n=28), and Death group (n=16). The Liver transplantation and Death groups were combined into an Unfavorable prognosis group. We analyzed the prognostic factors including the Model for End-Stage Liver Disease (MELD) scores determined at 3-day intervals. RESULTS: A multivariable analysis showed that the unfavorable prognostic factors were a high initial MELD score (> or =28) (odds ratio [OR] =6.64, p=0.015), moderate-to-severe ascites at admission (OR=6.71, P=0.012), and the aggravation of hepatic encephalopathy during hospitalization (> or =grade III) (OR=15.41, P=0.013). Compared with the baseline level, significant reductions in the MELD scores were observed on the 7th day after admission in the Recovery group (P=0.016). CONCLUSIONS: Dynamic changes in clinical parameters during admission are useful prognostic factors for hepatitis-B-related acute-on-chronic liver failure.
Acute-On-Chronic Liver Failure/*diagnosis/drug therapy/etiology ; Adult ; Aged ; Antibodies, Monoclonal, Murine-Derived/therapeutic use ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Antiviral Agents/therapeutic use ; Cyclophosphamide/therapeutic use ; DNA, Viral/analysis ; Doxorubicin/therapeutic use ; Female ; Hepatitis B virus/genetics ; Hepatitis B, Chronic/complications/*diagnosis/drug therapy ; Hospitalization ; Humans ; Liver Transplantation ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Prednisone/therapeutic use ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Vincristine/therapeutic use ; Young Adult