The case of an 33-year-old man with an intradural and extramedullary enterogenous cyst in the thoracic spinal canal is presented. Enterogenous cysts are rare cystic tumors located in the spinal canal and causing spinal compression, and about half of the cases of enterogenous cysts are associated with congenital anomalies. This patient, however, had no vertebral anomaly or other evidence of congenital melformation. We reviewed literatures and recorded the distinguished features of intraspinal enterogenous cysts and discuss the clinical, radiological and histological findings.
Adult ; Humans ; Spinal Canal*

OBJECTIVES: The authors would report the results of definitive radiation therapy (RT) for early glottic cancer by two different radiation dose schedules. METHODS: From February of 1995 till June of 2008, 157 patients with T1-2N0 glottic cancer were treated with curative RT at Samsung Medical Center. All patients had squamous cell carcinoma, and there were 89 patients (56.7%) with T1a, 36 (22.9%) with T1b, and 32 (20.4%) with T2. Two different radiation dose schedules were used: 70 Gy in 35 fractions to 64 patients (40.8%, group A); and 67.5 Gy in 30 fractions to 93 patients (59.2%, group B). The median treatment durations were 50 days (range, 44 to 59 days) and 44 days (range, 40 to 67 days) in the groups A and B, respectively. RESULTS: The median follow-up durations were 85 and 45 months for the groups A and B. No severe late complication of RTOG grade 3 or higher was observed, and there was no difference in acute or chronic complication between the groups. Twenty-four patients experienced treatment failure: local recurrence only in 19 patients; regional recurrence only in one; combined local and regional recurrence in four; and systemic metastasis in none. The overall 5-year disease-free survival and disease-specific survival rates were 84.7% and 94.8%. The disease-free survival rate in the group B was better (78.3% vs. 90.8%, P=0.031). This difference was significant only in T1 stage (83.4% vs. 94.6%, P=0.025), but not in T2 (62.7% vs. 60.6%, P=0.965). Univariate analysis showed that the tumor extent, cord mobility, T-stage, and the dose schedule had significant influence on the disease-free survival, and multivariate analysis showed that only the tumor extent and the dose schedule were associated with the disease-free survival. CONCLUSION: Superior disease-free survival could be achieved by 2.25 Gy per fraction without increased toxicity over shorter RT duration, when compared with 2.0 Gy per fraction.
Appointments and Schedules ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Dose Fractionation ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; Multivariate Analysis ; Neoplasm Metastasis ; Recurrence ; Survival Rate

PURPOSE: In living donor kidney transplantation, the initial function of donor's kidneys will be split into the function of the donor's remnant kidney and the recipient's implanted kidney. The question whether the function of these remnant and implanted kidneys will change after donation and transplantation was addressed. METHODS: The functional ratio of each kidney using (99m)Tc-Diethylenetriamine pentaacetic acid ((99m)Tc-DTPA) as well as serum creatinine (Scr, mg/dL) and 24-hour urine creatinine clearance (Ccr, mL/min/ 1.73 m(2)) from 100 donors were measured before donation. The kidney function was also calculated using Cockcroft-Gault formula (Ccr-CG, mL/min/ 1.73 m(2)). In donors and recipients, the Scr, Ccr, Ccr-CG were measured within a week after transplantation. RESULTS: The average functional ratio of the implanted kidney versus the remnant kidney before donation was 50.7 : 49.3. In implanted kidneys, the predonation Ccr and Ccr-CG were 56.7+/-9.4 mL/min/1.73 m(2) and 42.0+/-9.9 mL/min/1.73 m(2) which increased to 78.5+/-18.2 mL/min/1.73 m(2) and 53.2+/-16.4 mL/min/ 1.73 m(2) after transplantation. In remnant kidneys, the predonation Ccr and Ccr-CG were 54.5+/-10.9 mL/min/1.73 m(2) and 40.8+/-9.4/min/1.73 m(2) then increased to 68.0+/-14.2 mL/min/ 1.73 m(2) and 53.6+/-11.6 mL/min/1.73 m(2) after donation. CONCLUSION: Kidney transplantation from a living donor should be encouraged based on the total functional benefit of both donors and recipients after kidney donation and implantation.
Creatinine ; Glomerular Filtration Rate* ; Humans ; Kidney Transplantation* ; Kidney* ; Living Donors* ; Tissue Donors

Purpose: The overall incidence of central precocious puberty (CPP) has increased in recent decades, and brain magnetic resonance imaging (MRI) evaluations are recommended in cases of suspected brain lesions. This study aimed to investigate the prevalence of MRI abnormalities and to evaluate the need for routine brain MRI in patients with newly diagnosed CPP. Methods: This retrospective study reviewed the data of patients newly diagnosed with CPP who underwent routine pituitary MRI at Korea University Anam Hospital from March 2020 to September 2021. A total of 199 girls and 24 boys was enrolled in this study. Positive MRI findings were categorized as abnormal pituitary, nonpituitary incidental, and pathological. In addition, we investigated the incidence of MRI abnormalities and evaluated their associations with clinical and biochemical factors. Results: Positive brain MRI findings were observed in 84 patients (37.7%). Pituitary abnormalities were found in 54 patients (24.2%), with Rathke cleft cysts being the most common (16.1%). Incidental nonpituitary findings were observed in 29 patients (13.0%), while a pathological brain lesion (diagnosed as hypothalamic hamartoma) was observed in only 1 female patient (0.4%). No significant differences in sex or age were found in incidence of pituitary abnormalities or nonpituitary incidental findings. Compared with headache controls, significant associations were observed between abnormal pituitary findings on MRI and CPP (unadjusted odds ratio, 3.979; 95% confidence interval, 1.726–9.173). Conclusion True pathological findings were rare, even though the prevalence of abnormalities on pituitary MRI in patients with CPP was relatively high. Considering its cost-effectiveness, MRI screenings should be carefully considered in patients with CPP.

BACKGROUND/AIMS: Biphenyl dimethyl dicarboxylate (DDB) combined with garlic oil (pennel) has been used to treat chronic liver disease. A randomized, double-blind, active- and placebo-controlled clinical trial was conducted to investigate the efficacy, safety and quality of life in chronic liver disease patients. METHODS: A total of 237 patients with chronic liver disease were randomized into three groups; 100 patients were administered pennel, 102 patients Legalon as an active-control and 35 patients placebo for 12 weeks. The primary endpoint was the rate of alanine aminotransferase (ALT) normalization. We assessed differences in ALT levels and malondialdehyde (MDA) as an oxidative biomarker between 0 and 12 weeks, the improvement in quality of life using a chronic liver disease questionnaire (CLDQ) and the incidence of adverse events. RESULTS: Among 237 patients, there were 157 patients with non-alcoholic fatty liver disease, 36 patients with alcoholic liver disease, and 28 patients with chronic hepatitis B and C. The incidence of ALT normalization at 12 weeks was 89% for the pennel group, 18.6% for the active-control group, and 22.9% for the placebo-control group (p < 0.001). The difference in serum ALT level between 0 and 12 weeks was significantly higher in the pennel group (p < 0.001) and the level of MDA was decreased in the pennel group, statistically (p < 0.001). There was no difference in incidence of adverse events among groups. The pennel group showed significant improvement based on the CLDQ (p < 0.001). CONCLUSIONS: Pennel can effectively improve the rate of ALT normalization and the quality of life with a safety profile in chronic liver disease.
Alanine Transaminase ; Fatty Liver ; Garlic* ; Hepatitis B, Chronic ; Humans ; Incidence ; Liver Diseases* ; Liver Diseases, Alcoholic ; Liver* ; Malondialdehyde ; Quality of Life ; Surveys and Questionnaires ; Silymarin

BACKGROUND/AIMS: Biphenyl dimethyl dicarboxylate (DDB) combined with garlic oil (pennel) has been used to treat chronic liver disease. A randomized, double-blind, active- and placebo-controlled clinical trial was conducted to investigate the efficacy, safety and quality of life in chronic liver disease patients. METHODS: A total of 237 patients with chronic liver disease were randomized into three groups; 100 patients were administered pennel, 102 patients Legalon as an active-control and 35 patients placebo for 12 weeks. The primary endpoint was the rate of alanine aminotransferase (ALT) normalization. We assessed differences in ALT levels and malondialdehyde (MDA) as an oxidative biomarker between 0 and 12 weeks, the improvement in quality of life using a chronic liver disease questionnaire (CLDQ) and the incidence of adverse events. RESULTS: Among 237 patients, there were 157 patients with non-alcoholic fatty liver disease, 36 patients with alcoholic liver disease, and 28 patients with chronic hepatitis B and C. The incidence of ALT normalization at 12 weeks was 89% for the pennel group, 18.6% for the active-control group, and 22.9% for the placebo-control group (p < 0.001). The difference in serum ALT level between 0 and 12 weeks was significantly higher in the pennel group (p < 0.001) and the level of MDA was decreased in the pennel group, statistically (p < 0.001). There was no difference in incidence of adverse events among groups. The pennel group showed significant improvement based on the CLDQ (p < 0.001). CONCLUSIONS: Pennel can effectively improve the rate of ALT normalization and the quality of life with a safety profile in chronic liver disease.
Alanine Transaminase ; Fatty Liver ; Garlic* ; Hepatitis B, Chronic ; Humans ; Incidence ; Liver Diseases* ; Liver Diseases, Alcoholic ; Liver* ; Malondialdehyde ; Quality of Life ; Surveys and Questionnaires ; Silymarin

BACKGROUND/AIMS: The therapeutic strategies of applying adefovir for treating lamivudine resistant HBV mutants are controversial. Thus, we observed the clinical outcomes after discontinuation of lamivudine to establish the timing to initiate adefovir therapy. METHODS: Fifty chronic hepatitis B (CHB) patients with lamivudine resistant HBV mutants who had received lamivudine for more than 12 months were included in the study. We investigated the clinical outcomes at 6 months after the end of treatment (EOT). We compared the serial clinical outcomes among respective groups based on serum ALT at the EOT and the clinical characteristics of patients with or without acute exacerbation (AE) and the HBeAg loss. We also investigated the predictive parameters of AE and HBeAg loss. RESULTS: Fifteen patients (30%) had experienced AE at 6 months after the EOT. Four patients received antiviral agents because of their hepatic decompensation. Patients with AE had higher serum ALT values and lower HBV DNA titers at EOT compared with those patients without AE. Serum ALT at the EOT was the predictive parameter of AE. Eight patients (21.6%) had newly developed HBeAg loss at 6 months after EOT. The total bilirubin at EOT was the predictive parameter of HBeAg loss. CONCLUSIONS: CHB patients with lamivudine resistant HBV mutants had favorable clinical outcomes at 6 months after EOT. Therefore, we can consider observing the clinical courses after discontinuation of lamivudine and it is not always required to overlap the adefovir for treating lamivudine resistant HBV mutants except for the treatment of patients with a high risk of developing decompensation.
Adenine/administration & dosage/analogs & derivatives ; Adult ; Antiviral Agents/*administration & dosage ; *Drug Resistance, Viral ; English Abstract ; Female ; Hepatitis B e Antigens/blood ; Hepatitis B virus/drug effects ; Hepatitis B, Chronic/*drug therapy/virology ; Humans ; Lamivudine/*administration & dosage ; Male ; Middle Aged ; Phosphonic Acids/administration & dosage ; Reverse Transcriptase Inhibitors/*therapeutic use ; Treatment Outcome

PURPOSE: In radiotherapy for cervix cancer, both 3-dimensioal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) could reduce the dose to the small bowel (SB), while the small bowel displacement system (SBDS) could reduce the SB volume in the pelvic cavity. To evaluate the effect of the SBDS on the dose to the SB in 3D-CRT and IMRT plans, 3D-CRT and IMRT plans, with or without SBDS, were compared. MATERIALS AND MEHTODS: Ten consecutive uterine cervix cancer patients, receiving curative radiotherapy, were accrued. Ten pairs of computerized tomography (CT) scans were obtained in the prone position, with or without SBDS, which consisted of a Styrofoam compression device and an individualized custom-made abdominal immobilization device. Both 3D-CRT, using the 4-field box technique, and IMRT plans, with 7 portals of 15 MV X-ray, were generated for each CT image, and prescribed 50 Gy (25 fractions) to the isocenter. For the SB, the volume change due to the SBDS and the DVHs of the four different plans were analyzed using paired t-tests. RESULTS: The SBDS significantly reduced the mean SB volume from 522 to 262 cm3 (49.8% reduction). The SB volumes that received a dose of 10~50 Gy were significantly reduced in 3D-CRT (65~80% reduction) and IMRT plans (54~67% reduction) using the SBDS. When the SB volumes that received 20~50 Gy were compared between the 3D-CRT and IMRT plans, those of the IMRT without the SBDS were significantly less, by 6~7%, than those for the 3D-CRT without the SBDS, but the volume difference was less than 1% when using the SBDS. CONCLUSION: The SBDS reduced the radiation dose to the SB in both the 3D-CRT and IMRT plans, so could reduce the radiation injury of the SB.
Cervix Uteri* ; Female ; Humans ; Immobilization ; Prone Position ; Radiation Injuries ; Radiotherapy ; Uterine Cervical Neoplasms*

BACKGROUND: Previous studies showed that great difference of inter-arm blood pressure (IABP) was associated with adverse cardiovascular outcomes. However, these studies had measurement bias because blood pressure (BP) was measured sequentially for each arm. Then, the aim of present study, using simultaneous BP measurement, is to investigate the association between ankle brachial index (ABI), brachial ankle pulse wave velocity (baPWV) and IABP difference in patients without cardiovascular disease. METHODS: We conducted cross sectional study from medical data and selected 153 (116 men, 37 women) patients aged 18 years or older. Simultaneous BP measurements were recorded using automatic oscillometric monitor equipped with dual arm cuffs in both arms. At the same day, ABI, baPWV, and physical parameters were evaluated. RESULTS: The mean age of the subjects was 52.8 +/- 9.9 and the difference of inter-arm systolic BP (SBP) and diastolic BP (DBP) were 5.6 +/- 4.3 and 4.5 +/- 3.7 mm Hg. Compared with group with an inter-arm SBP difference less than 5 mm Hg, group with an inter-arm SBP difference more than 5 mm Hg was more older (p = 0.012), more higher proportion of patient whose left arm SBP was higher than right (p = 0.004), higher left arm SBP (p = 0.044) and higher baPWV (p = 0.025). However, the difference of IABP in SBP and DBP had no significant correlation with the age (r = 0.152, p = 0.06 and r = 0.03, p = 0.715), ABI (r = 0.021, p = 0.801 and r = 0.131, p = 0.105) and baPWV (r = 0.115, p = 0.158 and r = 0.068, p = 0.403). CONCLUSIONS: There were no significant correlation between the differences of IABP in simultaneous BP measurements and ABI, baPWV.
Adult ; Ankle Brachial Index ; Atherosclerosis* ; Blood Pressure Determination* ; Blood Pressure ; Humans ; Pulse Wave Analysis

Portal vein thrombosis (PVT) is a form of venous thrombosis that usually presents in chronic form without any sequalae in patients with hepatocellular carcinoma (HCC) or liver cirrhosis. Accurate differential diagnosis of bland PVT from neoplastic PVT is an important step for planning treatment options, but the acute form can be challenging. Here we present a case of acute hepatic infarction caused by acute bland PVT combined with pylephlebitis, which was misdiagnosed as infiltrative hepatic malignancy with neoplastic PVT owing to the perplexing imaging results and elevated tumor markers.
Biomarkers, Tumor ; Carcinoma, Hepatocellular ; Diagnosis, Differential ; Hepatitis B, Chronic ; Humans ; Infarction* ; Liver Cirrhosis ; Portal Vein* ; Tenofovir ; Thrombophlebitis* ; Thrombosis* ; Venous Thrombosis