PURPOSE: To determine the clinical and demographic factors associated with long-term remission of valproate(VPA) therapy in childhood absence epilepsy. METHODS: Fifty-six cases of childhood and juvenile absence epilepsy were identified by reviewing of Electroencephalographic records and medical charts. Thirty-six cases were initially treated with VPA. Factor associated with responsiveness were identified by uni- and mutivariate logistic regression. RESULTS: Twenty-seven patient achieved long-term remission(75%). Failure to achieve remission was more likely if the initial treatment of VPA had failed than if it was successful(53% versus 90.4%, P<0.02) was also associated with failure of long-term remission. Lamotrigine was more efficacious add-on drug than Ethosuximide(63.6% vs 25% P=0.04). CONCLUSION: Long-term seizure remission was related to the patient's initial response to VPA.
Demography ; Epilepsy ; Epilepsy, Absence ; Humans ; Logistic Models ; Seizures ; Triazines ; Valproic Acid

Tuberous sclerosis is an autosomal dominant disorder of cellular differentiation that affect the brain, skin, heart, kidney and other organs. We experienced three cases of tuberous sclerosis that affect multiple organs in mother and two daughters. We report these cases with brief review and related literatures.
Brain ; Heart ; Humans ; Kidney ; Mothers* ; Nuclear Family* ; Skin ; Tuberous Sclerosis*

Uterine tumors resembling ovarian sex-cord tumors (UTROSCT) are very rare tumors that occur mainly in the uterine fundus of women in reproductive age. These tumors can be classified into group 1 and group 2 by histological results. In group 1, epithelial-like differentiation is partially observed in the tumors. In group 2, sex-cord elements are predominant in uterine mural mass. We experienced UTROSCT group 1 in a 29-year-old woman who complained of severe abdominal pain that started one week after delivery and UTROSCT group 2 case in a 49-year-old woman who complained of dysfunctional uterine bleeding. We report two different types of UTROSCT cases that we experienced.
Abdominal Pain ; Adult ; Female ; Humans ; Metrorrhagia ; Middle Aged ; Sex Cord-Gonadal Stromal Tumors ; Uterine Diseases ; Uterine Neoplasms

PURPOSE: Moyamoya disease is a chronic cerebrovascular illness characterized by bilateral stenoses or occlusions of the arteries around the circle of Willis with prominent collateral circulation. We studied 36 children and adolescents with Moyamoya disease to evaluate the clinical features and outcomes. METHODS: Records were reviewed of 36 pediatric patients admitted at the Busan Paik Hospital for Moyamoya disease between January 2000 and July 2007. The clinical records were reviewed in terms of the patient profiles, imaging findings, surgical techniques, and pathologic findings. RESULTS: Overall clinical features, responses to treatment and outcome were nearly same as those of other previous reports in Korea as well as the other countries. The mean age of onset was 8 years and 5 months and the ratio of male to female was 1:1.2. Ischemia was more often than infarction(5.6: 1). Half of the patients had conservative therapy and 17 cases(47%) were treated with EDAS. CONCLUSION: The clinical features of childhood Moyamoya disease are similar to the result from other studies in Korea.
Adolescent* ; Age of Onset ; Arteries ; Busan ; Child* ; Circle of Willis ; Collateral Circulation ; Constriction, Pathologic ; Female ; Humans ; Ischemia ; Korea ; Male ; Moyamoya Disease*

After surgical operation in patients with arteriovenous malformation (AVM), normal pressure perfusion breakthrough (NPPB) is one of the major complications. Brain perfusion SPECT with acetazolamide stress was known to be useful to evaluate the vascular reserve in several neurological and neurosurgical conditions. The authors performed acetazolamide brain perfusion SPECT in patients with AVM and compared the brain perfusion in the post-operative clinical courses. The acetazolamide brain perfusion SPECT was helpful in defining the prognosis of the patients with AVM. We describe 4 patients with AVM who had acetazolamide brain perfusion SPECT to examine the prognosis.
Acetazolamide* ; Arteriovenous Malformations* ; Brain* ; Humans ; Perfusion* ; Prognosis* ; Technetium Tc 99m Exametazime ; Tomography, Emission-Computed, Single-Photon*

The diagnosis of acute pancreatitis occurred in CAPD patients is quite difficult due to its clinical similarity with acute peritonitis. Delayed diagnosis and treatment of acute pancreatitis in CAPD patients may result in fatal complication. We experienced a case of acute pancreatitis in a CAPD patient. A 62 years old female visited the hospital with acute abdominal pain and cloudy effluent for 3 days. She has been on CAPD for 3 years and had two episodes of peritonitis at 6 months and 1 year before the admission. The causative organism was Streptococcus viridans in each episode. The peritonitis symptoms and peritoneal leukocyte count incresed despite of using Vancomycin(R) and Netilmicin(R). Causative organism was not isolated from dialysis. Serum amylase concentrations increased from 105mg/dL at the admission to 1,052mg/dL on day 10 of admission. Abdominal ultrasonography and abdominal computerized tomogram revealed fat infiltration, focal necrosis and multiple cyst formation at pancreas area. Computerized tomogram guided aspiration cytology revealed acute inflammation and necrosis. Bacteria were not found in the aspirate. Clinical symptoms were improved after discontinuation of CAPD and intraperitoneal use of antibiotics. The patient restarted CAPD on the day 18 and remained without complications. We report this case with a brief review of literatures.
Abdominal Pain ; Amylases ; Anti-Bacterial Agents ; Bacteria ; Delayed Diagnosis ; Diagnosis ; Dialysis ; Female ; Humans ; Inflammation ; Leukocyte Count ; Middle Aged ; Necrosis ; Pancreas ; Pancreatitis* ; Peritoneal Dialysis, Continuous Ambulatory* ; Peritonitis ; Renal Dialysis ; Ultrasonography ; Viridans Streptococci

PURPOSE: Anaplastic thyroid cancer (ATC) is a rare but highly aggressive neoplasm with a dismal prognosis. However, a few patients survive for a long time after treatment. We tried to identify prognostic factors of this disease and analyzed treatment outcomes in patients with ATC. METHODS: We reviewed the medical records of 15 patients diagnosed with ATC in our institution between 1988 and 2003. The survival was compared by the Kaplan-Meier logrank test using SPSS program. RESULTS: The female-to-male ratio was 1.5:1 (9 women and 6 men), and the mean age at diagnosis was 63.9 years (range, 44~91). The mean tumor size was 6.3 cm (range, 4~10 cm). Extrathyroidal invasion was present in 12 cases and distant metastasis at diagnosis was present in 6 cases. Surgery was performed in 8 cases. Radiotherapy was used for 10 cases and chemotherapy for 5 cases. The mean overall survival time of the 15 patients was 237 days (range, 28~717 days). The 6~, 12~, 18~ and 24~ month survival rates were 33%, 26%, 13% and 0%. No association was found between survival and presenting symptoms, age, gender, tumor size, previous goiter history, extrathyroidal invasion, distant metastasis, surgery, radiotherapy or chemotherapy. A significantly better outcome was observed in patients received triple modality treatment (surgery, radiotherapy and chemotherapy) than in those received single or dual modality treatment (P=0.05). CONCLUSION: Although most patients with ATC had a poor prognosis, a multimodal approach including surgery, radiotherapy and chemotherapy, might improve survival.
Diagnosis ; Drug Therapy ; Female ; Goiter ; Humans ; Medical Records ; Neoplasm Metastasis ; Prognosis ; Radiotherapy ; Survival Rate ; Thyroid Carcinoma, Anaplastic*

PURPOSE: Differentiated thyroid cancer is known to be one of cancers which have a favorable prognosis and long-term survival resulting from slow growth of tumor and late distant metastasis. Patients are nearly cured of thyroid cancer after first operation. But, some of those have high risk factors of recurrence. Practically it has been reported that 20% of those have recurrence of cancer and 50~60% of patients died of recurrence. We analyzed factors involving to recurrence after initial treatment, frequency and site of recurrence, disease-free interval, and results of treatment. Based on this information, we investigated therapeutics to decrease the rate of recurrence and prognostic factors to expect death. METHODS: 1803 patients were primarily operated for thyroid cancer in Kyungpook National University Hospital between 1985 and 2003. Among the cases, we reviewed the clinical records of 124 patients (6.9%) who had recurrent thyroid cancer. We analyzed the difference in frequency of recurrence on the basis of sex, age, histologic types, risk groups, and lymph node metastases when they had a first operation. The correlation between these factors and mortality rate was analyzed statistically by using Chi-square test and Fisher's exact probability test. RESULTS: Post-operative recurrence of thyroid cancer was highly observed in over 40 years old at first operation (8.4% vs. 4.9%), men (17.1% vs. 3.9%). Similarly, in the case of medullary or poorly-differentiated thyroid cancers, the groups of patients with high-risk (12.3% vs. 3.9%) or with lymph node metastases (13.5% vs. 3.7%) have high frequency of recurrence. Among the 124 patients, 53.3% cases have regional recurrence sites and 20.1% have local, 17.7% distant metastases, and 1.6% combined locoregional. The number of patients who died of recurrent cancer was 32 of 124 cases. Major cause of the death was distant metastases. In the case of 104 patients who had recurrent differentiated thyroid cancer, significant prognostic indicators of low survival rates are age greater than 45 years, neck dissection at second operation and distant metastases. CONCLUSION: In order to decrease the rate of local and regional recurrence in thyroid cancer, we conclude that complete resections of thyroid tissue and cervical lymph nodes have to be operated specially in the group with high-risk. Although adjacent organs are infiltrated, active treatment should be carried out. The treatment of most medullary or poorly-differentiated thyroid cancers which result in the death of distant metastases still remains to be studied.
Gyeongsangbuk-do ; Humans ; Lymph Nodes ; Male ; Mortality ; Neck Dissection ; Neoplasm Metastasis ; Prognosis* ; Recurrence ; Risk Factors* ; Survival Rate ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: High-resolution ultrasound is a safe and costeffective method of identifying and characterizing thyroid nodules, and also for guiding aspiration cytology. But differentiating malignancy from the more frequently occurring benign thyroid nodules has proved challenging as there may be significant overlap in their sonographic appearance. The purpose of this study was to correlate the sonographic characteristics of thyroid nodules with the pathologic results after thyroidecotmy, and to establish the relative importance of these features for predicting the risk for malignancy. METHODS: We reviewed 516 thyroid nodules in 413 patients who underwent thyroidectomy between August 2003 and May 2005, after routine preoperative ultrasound. The following sonographic characteristics of the nodules were evaluated and we determined their sensitivity, specificity and positive predictive value: shape, margin, presence of halo, echo structure, internal echo, echogenicity, calcification and the type of vascularization. RESULTS: Of the 516 nodules, 327 were malignant nodules and 189 were benign nodules. The nodule size ranged from 5 to 80 mm at the greatest dimension (mean: 20.6 mm). The shape, margin, absence of halo, echo structure, and echogenecity showed statistically significant differences between the benign and malignant nodules in this study. Microcalcifications had low sensitivity but high specificity (13.1% vs 98.9%, respectively). Various combinations of features that have been suggested to be significant predictors of malignancy were also analyzed. The presence of all features was 100% specific for malignancy. According to the receiver operating characteristic curve, the best point for not over-looking malignancy is 2.5. At greater than this point, fine needle aspiration cytology is needed. CONCLUSION: This study has shown that ultrasonography is useful for differentiating between benign and malignant thyroid nodules and it can provide the proper indications for aspiration cytology.
Biopsy, Fine-Needle ; Diagnosis, Differential* ; Humans ; ROC Curve ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Nodule* ; Thyroidectomy ; Ultrasonography*

A case is reported of downbeat nystagmus associated with compression of the root of vestibulocochlear nerve by vertebral arteries, which was revealed by magnetic resonance imaging. Chief complain of the patient was positional vertigo, which aggrevated at left decubitus position. Downbeat nystagmus was increased in left Dix-hall pike test. Tetsuo et al, reported downbeat nystagmus with compression of dolichoectatic vertebral arteries to the medulla oblongata and surgical neurovascular decompression of the dolichoectasia reverses the progression of symptoms if permanent neurologic damage has not already occurred.
Decompression ; Esocidae ; Humans ; Magnetic Resonance Imaging ; Medulla Oblongata ; Nystagmus, Pathologic ; Vertebral Artery* ; Vertebrobasilar Insufficiency ; Vertigo ; Vestibulocochlear Nerve*