No abstract available.

Sustained downgaze mostly occurs in association with lesions affecting the dorsal midbrain. We report sustained downgaze in a patient with hepatic encephalopathy. The sustained downgaze existed for seven more days after she regained her consciousness. The persistent downgaze even after regaining full consciousness indicates localized pretectal dysfunction rather than diffuse encephalopathy as the mechanism of sustained downgaze in our patient. The ocular motor dysfunction in hepatic encephalopathy may be due to localized dysfunction of the brainstem

This study aimed to evaluate the effects of volume adapted re-planning for radiotherapy (RT) after gross total resection (GTR) for glioblastoma. Nineteen patients with glioblastoma who underwent GTR and postoperative RT were analyzed. The volumes of the surgical cavity on computed tomography (CT) obtained one day after GTR (CT0), the first RT simulation CT (sim-CT1), and the second simulation CT for the boost RT plan (sim-CT2) were compared. The boost RT plan was based on the surgical cavity observed on the sim-CT2 (boost RTP2) and was compared with that based on the surgical cavity observed on the sim-CT1 (boost RTP1). The volume reduction ratios were 14.4%-51.3% (median, 29.0%) between CT0 and sim-CT1 and -7.9%-71.9% (median, 34.9%) between sim-CT1 and sim-CT2 (P < 0.001). The normal brain volumes in boost RTP1 were significantly reduced in boost RTP2, especially at high dose levels. Target volume in sim-CT2 which was not covered with the boost RTP1, developed in five cases (26.3%). The surgical cavity volume was reduced following surgery in patients with glioblastoma who underwent GTR. The application of volume-adapted re-planning during RT could decrease the irradiated volume of normal brain and prevent a target miss for boost RT.
Aged ; Aged, 80 and over ; Brain Neoplasms/*radiotherapy/surgery ; Female ; Glioblastoma/*radiotherapy/surgery ; Humans ; Male ; Middle Aged ; Radiotherapy Dosage ; Radiotherapy Planning, Computer-Assisted ; Tomography, X-Ray Computed

Objective: Emergency physicians frequently encounter suicidal attempt patients. Some of the patients are intoxicated with the pesticides. Unlike medical drugs, finding out detailed information in terms of human toxicity is not easy. In Korea, there is the crop protection substance guidebook, and the toxicity grade is noted in that book. However, little is known about the patients’ characteristics and outcomes with slightly hazardous substances. Methods: This is a retrospective, single-center study. The study duration was 2 years. We investigated the pesticideintoxicated patients who visited our emergency department. The patients were divided according to toxicity grades, including slightly hazardous, moderately hazardous, highly hazardous and extremely hazardous. Initial vital signs, mental status, laboratory values, therapeutic modalities and therapeutic outcomes were investigated. Results: Among a total of 472 patients, 110 (23.3%) were pesticide-intoxicated patients. Intensive care unit (ICU) admission rate and mortality rate were higher, and ICU admission duration was longer in the pesticide-intoxicated patients. The deterioration of initial arterial blood gas values (41.2%), hypokalemia or hyperkalemia (32.4%), acute kidney injury (17.6%), troponin elevation (8.8%), and rhabdomyolysis (3.4%) were noted in the slightly hazardous group. Continuous renal replacement therapy, endotracheal intubation and vasopressor use were performed in some of them. The seizure, shock and cardiac arrest were also developed. More than half of patients (52.9%) were admitted to the ICU. Conclusion Significant limitation of relying on the toxicity grade was noted. In the low-grade toxicity pesticide group, some patients were deteriorated. Therefore, caution is needed when treating pesticide intoxication patients.

Congenital triangular alopecia is an uncommon nonscarring form of alopecia. It presents with isolated alopecic patch at the frontotemporal area of the scalp. Although previously considered congenital, this condition usually is discovered after 2 years of age and, more recently, is thought to be acquired. We report a case of congenital triangular alopecia in a 12 month old female who had the lesion since birth.
Female ; Humans

Anti-glomerular basement membrane antibody mediated rapidly progressive glomerulonephritis is a rare autoimmune disease. It is characterized by acuterenal failure and crescentic glomeruli with linear immune deposits along glomerular basement membrane mediated by anti-GBM antibodies. We report a case of a sixty-years-old man with generalized edema and hematuria. On admission, BUN/Creatinine was 118/19.6 mg/dL, Hb was 10.2 g/dL. On urinalysis, protein was 3+, and many RBCs were found. Renal biopsy specimen which contained 8 glomeruli showed active cellular crescent formation in all glomeruli. On immunofluorescent staining specimen, there were 4 glomeruli which showed strong IgG linear staining along the glomerular basement membrane and mild C3 & C1q deposit along the capillary walls. The titer of anti-GBM antibody was 123 EU by ELISA (normal: <10 EU). We treated with high dose of corticosteroid and plasmapheresis, but renal function was not recovered even after 3 months of hemodialysis.
Antibodies ; Autoimmune Diseases ; Basement Membrane* ; Biopsy ; Capillaries ; Edema ; Enzyme-Linked Immunosorbent Assay ; Glomerular Basement Membrane ; Glomerulonephritis ; Hematuria ; Hemorrhage* ; Immunoglobulin G ; Plasmapheresis ; Renal Dialysis ; Urinalysis

PURPOSE: Routine evaluation of kidney donors occasionally reveals an incidental renal mass with an otherwise satisfactory kidney function. The use of such a kidney with an enhancing mass for transplantation is a matter of debate owing to a possible risk of transmission of donor malignancies. We report our experience of kidney transplants from donors with renal cell carcinoma, after ex vivo resection of the renal mass. METHODS: Two women aged 44 and 56 years were diagnosed with enhancing renal masses measuring 0.9 cm and 0.7 cm, respectively, during donor evaluation for kidney transplantation. Both patients and their families were informed of a potential risk of recurrent renal cell carcinoma following transplantation. RESULTS: Renal function test results of both donors satisfied the living donor selection criteria. Laparoscopic live donor nephrectomy was performed with ex vivo resection of renal masses on the bench table. Immediate pathological analysis revealed a renal cell carcinoma with a margin of normal renal parenchyma before transplantation. Regimens based on mammalian target of rapamycin inhibitors, which are known for their antitumoral properties, were used for immunosuppression in both recipients. None of the recipients showed recurrence or metastasis during the follow-up period, which was longer than 3 years after transplantation. CONCLUSION: In light of the ongoing shortage of kidney donors, kidneys with small renal cell carcinoma could be considered for transplantation after appropriate removal of the lesion, with a very low risk of recurrent disease.
Carcinoma, Renal Cell* ; Female ; Follow-Up Studies ; Humans ; Immunosuppression ; Kidney ; Kidney Transplantation ; Living Donors ; Neoplasm Metastasis ; Nephrectomy* ; Patient Selection ; Recurrence ; Sirolimus ; Tissue Donors*

OBJECTIVE: The objective of this study was to determine relationship between alteration of expression of E-cadherin, beta-catenin and tumor progression, clinical stage, lymph node metastasis, age of patients with uterine cervical cancer. METHODS: The authors evaluated the immunohistochemical expression pattern of E-cadherin and beta- catenin in relationship with tumor stage and clinicopathologic parameters in 71 cervical neoplasia including 36 cases of squamous cell carcinoma (SCC), 10 cases of microinvasive SCC, 22 cases of squamous cell carcinoma in situ, and 3 cases of severe dysplasia. RESULTS: There were aberrant expression in 76.1% of E-cadherin (54 of 71) and 74.6% of beta-catenin (53 of 71) in the cervical cancer. There was positive correlation of aberrant expression of E-cadherin with tumor progression and clinical stage (<0.005). There was positive correlation of aberrant expression of beta- catenin with tumor progression and clinical stage (<0.005). CONCLUSION: These results suggest that the degree or the pattern of E-cadherin, beta-catenin, and E-cadherin/beta-catenin complex may be related to histologic grade and clinical stage of uterine cervical cancer.
beta Catenin ; Cadherins ; Carcinoma, Squamous Cell ; Cervix Uteri* ; Female ; Humans ; Lymph Nodes ; Neoplasm Metastasis ; Uterine Cervical Neoplasms

PURPOSE: To evaluate the 1-year results of Descemet's membrane endothelial keratoplasty (DMEK) in Korea. METHODS: The medical records of 9 patients (10 eyes) with endothelial disease who underwent DMEK from January 2012 to December 2013, and were followed up for more than 12 months were reviewed retrospectively. RESULTS: In 8 eyes with successful results after surgery, best corrective visual acuity (BCVA) was significantly improved from 1.64 +/- 0.21 (log MAR, mean) to 0.35 +/- 0.22 at 1 month and was maintained at 12 months (p = 0.012, Wilcoxon signed ranks test). BCVA at postoperative 3, 6 and 12 months were gradually increased (0.25 +/- 0.23, 0.20 +/- 0.17 and 0.16 +/- 0.17 log MAR). Endothelial cell counts were 1,996 +/- 528/mm2, 1,564 +/- 174/mm2 and 1,463 +/- 541/mm2, 1,205 +/- 358/mm2 at 1, 3, 6, and 12 months after surgery, tended to decrease but showed no statistical significance. There was no statistical difference in astigmatism before and 3 months after the operation (3.32 +/- 2.36 diopter and 2.57+/- 1.44 diopter). Primary graft failure occurred in 2 eyes and 1 received reoperation. Total detachment was found in 1 eye. CONCLUSIONS: The 1-year results of DMEK showed fast visual recovery which was maintained for 12 months. DMEK may be a very efficient option for the surgical management of corneal endothelial disease.
Astigmatism ; Cornea ; Corneal Transplantation* ; Descemet Membrane* ; Endothelial Cells ; Humans ; Korea ; Medical Records ; Reoperation ; Retrospective Studies* ; Transplants ; Visual Acuity

Metformin, commonly prescribed for type 2 diabetes, is considered safe with minimal side-effect. Acute pancreatitis is rare but potentially fatal adverse side-effect of metformin. We report a patient on hemodialysis with metformin-related acute pancreatitis and lactic acidosis. A 62-year-old woman with diabetic nephropathy and hypertension presented with nausea and vomiting for a few weeks, followed by epigastric pain. At home, the therapy of 500 mg/day metformin and 50 mg/day sitagliptin was continued, despite symptoms. Laboratory investigations showed metabolic acidosis with high levels of lactate, amylase at 520 U/L (range, 30-110 U/L), and lipase at 1,250 U/L (range, 23-300 U/L). Acute pancreatitis was confirmed by computed tomography. No recognized cause of acute pancreatitis was identified. Metformin was discontinued. Treatment with insulin and intravenous fluids resulted in normalized amylase, lipase, and lactate. When she was re-exposed to sitagliptin, no symptoms were reported.
Acidosis ; Acidosis, Lactic* ; Amylases ; Diabetes Mellitus ; Diabetic Nephropathies ; Female ; Humans ; Hypertension ; Insulin ; Lactic Acid ; Lipase ; Metformin* ; Middle Aged ; Nausea ; Pancreatitis* ; Renal Dialysis* ; Sitagliptin Phosphate ; Vomiting