PURPOSE: To analyse the radiological findings of bizarre parosteal osteochondromatous proliferation (BPOP), a rare benign tumorous lesion with a high frequency of recurrence which frequently occurs around the short tubular bones of the hands and feet. MATERIALS AND METHODS: Between 1984 and 1998, 19 cases of BPOP were pathologically Proven, and in is of these, six men and nine women aged between 17 and 69(mean, 41) years, plain radiographs were available for analysis. We examined the location and size of lesions, and their relationship to adjacent bone. RESULTS: In all cases, trabecular bone formations were present. There were not separable from adjacent bones, which in all cases appeared normal. In nine of 15 cases margins were sharp, and in the remaining six they were irregular. Lesions were located around a phalanx of the hand (n=5), a metatarsal bone (n=3), a long bone (n=3), a phalanx of the foot (n=2), a metacarpal bone (n=1), and a metatarsophalangeal joint (n=1). Their average size was 2.5 x1.9cm, and in three of is cases the tumor recurred. CONCLUSIONS: BPOP showed a well-marginated mass of heterotopic mineral arising around short tubular bones. These findings were useful for diagnosis and differential diagnosis.
Diagnosis ; Diagnosis, Differential ; Female ; Foot ; Hand ; Humans ; Male ; Metatarsal Bones ; Metatarsophalangeal Joint ; Recurrence

Simple or unicameral bone cysts are metaphyseal lesions of long bones. They usually move away from the physiswith growth to become diaphyseal in location. Involvement of the physis and epiphysis by these cystic lesions isvery rare. This paper reports a case of simple bone cyst of the proximal humerus in a 11- year -old girl which wasshown by MR imaging to extend through the physis into the epiphysis.
Bone Cysts* ; Epiphyses* ; Female ; Humans ; Humerus* ; Magnetic Resonance Imaging

Giant cell tumor of bone is a locally aggressive benign neoplasm, which is composed of oval or plump, spindle-shaped mononuclear cells and uniformly distributed multinucleated giant cells. Bone or cartilage matrix production by the tumor cells is usually not seen. We present a pathologically proven case of giant cell tumor, arising in the acetabulum and pubic bone, with unusual cartilage matrix production. We also discuss the differential diagnosis from a chondroblastoma as well as a giant cell-rich osteosarcoma.
Acetabulum ; Cartilage* ; Chondroblastoma ; Diagnosis, Differential ; Giant Cell Tumor of Bone ; Giant Cell Tumors* ; Giant Cells* ; Osteosarcoma ; Pubic Bone

Giant cell tumors are distinctive neoplasms characterized by a profusion of multinucleate giant cells scattered throughout a stroma of mononuclear cells. Most giant cell tumors are found at the epiphyses of long bones, especially around the knee joint. Flat bone involvement is rare. However, a case of giant cell tumor with secondary aneurysmal bone cyst was encountered at the scapula of a 25-year-old man. Since the occurrence of a giant cell tumor with secondary aneurysmal bone cyst on flat bones (i.e., the scapula) is extremely rare, the above-mentioned case is worthy of reporting.
Adult ; Bone Cysts/*etiology/pathology ; Bone Neoplasms/*complications/pathology ; Giant Cell Tumors/*complications/pathology ; Humans ; Male ; Scapula

OBJECTIVE: There have been much effort to find reliable indicators predicting treatment response in panic disorder. This study aimed to find the effect of pharmacotherapy on biofeedback measurement variables in panic disorder patients. METHOD: We recruited 38 panic disorder patients (M:25, F:13) in the Samsung Medical Center, who were diagnosed by the ADIS-IV (Anxiety Disorder Interview Schedule-IV), and 33 normal control subjects (M:21 F:12). Panic patients were treated with paroxetine for 3 months. All subjects were assessed on forearm and frontal electromyography (EMG), electrodermal response (EDR), and skin temperature in baseline, stress, recovery phases using the Procomp & Biograph biofeedback instrument. Psychological measures such as Hamilton anxiety rating scale (HAM-A), Hamilton depression rating scale (HAM-D), Beck depression inventory (BDI), Spielberger state-trait anxiety inventory (STAI-S, STAI-T), and Anxiety sensitivity index (ASI) were also assessed. All measurements were performed at the beginning of the study and after 3 months of paroxetine treatment. RESULT: Panic patients had significantly higher scores on psychological measures such as HAM-A, HAM-D, BDI, STAI-S, STAI-T, and ASI (all p values<0.001) before treatment. After 3months of treatment, panic patients showed significant improvement on baseline EDR (z=-2.824, p=0.005), stress EDR (z=-2.691, p=0.007), and recovery EDR (z=-3.416, p=0.001). They also showed significant improvement on HAM-A, HAM-D, BDI, STAI-S, STAI-T, and ASI (all p values<0.001) after treatment. CONCLUSION: Electrodermal response, one of the biofeedback measurement variables, was suggested to be the possible indicator predicting treatment response in panic disorder.
Anxiety ; Biofeedback, Psychology* ; Depression ; Drug Therapy* ; Electromyography ; Forearm ; Galvanic Skin Response ; Humans ; Panic Disorder* ; Panic* ; Paroxetine* ; Skin Temperature

OBJECTIVE: To correlate CT parameters on detector-based dual-energy CT enterography (DECTE) with Crohn's disease activity index (CDAI) and externally validate quantitative CT parameters. MATERIALS AND METHODS: Thirty-nine patients with CD were retrospectively enrolled. Two radiologists reviewed DECTE images by consensus for qualitative and quantitative CT features. CT attenuation and iodine concentration for the diseased bowel were also measured. Univariate statistical tests were used to evaluate whether there was a significant difference in CTE features between remission and active groups, on the basis of the CDAI score. Pearson's correlation test and multiple linear regression analyses were used to assess the correlation between quantitative CT parameters and CDAI. For external validation, an additional 33 consecutive patients were recruited. The correlation and concordance rate were calculated between real and estimated CDAI. RESULTS: There were significant differences between remission and active groups in the bowel enhancement pattern, subjective degree of enhancement, mesenteric fat infiltration, comb sign, and obstruction (p < 0.05). Significant correlations were found between CDAI and quantitative CT parameters, including number of lesions (correlation coefficient, r = 0.573), bowel wall thickness (r = 0.477), iodine concentration (r = 0.744), and relative degree of enhancement (r = 0.541; p < 0.05). Iodine concentration remained the sole independent variable associated with CDAI in multivariate analysis (p = 0.001). The linear regression equation for CDAI (y) and iodine concentration (x) was y = 53.549x + 55.111. For validation patients, a significant correlation (r = 0.925; p < 0.001) and high concordance rate (87.9%, 29/33) were observed between real and estimated CDAIs. CONCLUSION: Iodine concentration, measured on detector-based DECTE, represents a convenient and reproducible biomarker to monitor disease activity in CD.
Consensus ; Crohn Disease* ; Humans ; Iodine* ; Linear Models ; Multivariate Analysis ; Retrospective Studies

Purpose: This study aimed to apply doxorubicin-loaded nanoparticle microbubble (Dox-NP-MB) therapy in an orthotopic rat model of hepatocellular carcinoma (HCC) and investigate the utility of contrast-enhanced ultrasound (CEUS) and intravoxel incoherent motion diffusion-weighted magnetic resonance imaging (IVIM-DWI) for response evaluation. Methods: Twenty-eight N1S1 HCC model rats were treated with either Dox-NP-MB (group [G] 1, n=8), doxorubicin (Dox) alone (G2, n=7), nanoparticle microbubbles alone (G3, n=7), or saline (G4, control, n=6) on days 0 and 7, and were sacrificed on day 11. IVIM-DWI and CEUS were performed before each treatment and before euthanasia. Efficacy was estimated by the percentage of tumor volume growth inhibition compared with control. Toxicity was assessed by body weight changes and blood tests. Post-treatment changes in IVIM-DWI and CEUS parameters were analyzed. Results: Tumor volume growth was inhibited by 48.4% and 90.2% in G1 and G2 compared to G4, respectively. Compared to G2, G1 had a significantly lower degree of body weight change (median, 91.0% [interquartile range, 88.5%-97.0%] vs. 88.0% [82.5%-88.8%], P<0.05) and leukopenia (1.75×103 cells/μL [1.53-2.77] vs. 1.20×103 cells/μL [0.89-1.51], P<0.05). After the first treatment, an increase in peak enhancement, wash-in rate, and wash-in perfusion index on CEUS was observed in G3 and G4 but suppressed in G1 and G2; the apparent diffusion coefficients, true diffusion coefficients, and perfusion fractions significantly increased in G1 and G2 compared to baseline (P<0.05). Conclusion Dox-NP-MB showed reduced Dox toxicity. Early changes in some CEUS and IVIM-DWI parameters correlated with the therapeutic response.

Primary small cell carcinoma of the liver is an extremely rare tumor. Extrapulmonary small cell carcinoma shares many features of pulmonary small cell carcinoma, including the histological appearance, the aggressive clinical behavior and the frequent short-lasting response to either chemotherapy or radiotherapy. We experienced a 56-year-old man with small cell carcinoma that arose in the liver. Abdominal CT scan showed an 8 cm size, low density mass in the segment 4 of the liver and also multiple lymphadenopathies. Chest X-ray showed no abnormal finding, but the chest CT showed a right lower paratracheal lymphadenopathy. The pathological findings showed nests of small round cells with fine granular chromatin, inconspicuous nucleoli and scanty cytoplasm. Distinct and strong immunoreactions were seen for CD56 and c-kit, and sparse immunoreaction was seen for synaptophysin. Thyroid transcription factor-1 showed no immunoreaction. The tumor did not decrease in size despite chemotherapy. We report this case along with a review of the relevant literatures.
Carcinoma, Small Cell/*diagnosis ; English Abstract ; Humans ; Liver Neoplasms/*diagnosis ; Male ; Middle Aged

The purpose of this study was to investigate the association between clinical variables and sudden unexpected death in epilepsy (SUDEP) and identify risk factors for SUDEP. SUDEP is one of the most frequent causes of death in patients with epilepsy. Previous studies have reported possible risk factors associated with SUDEP, but there need to be elucidated yet. The cases were 26 patients with SUDEP and three control patients were included for each case, matched for age, sex, and date of initial clinical visit. All demographic and clinical characteristics, including age, sex, disease duration, classification of epilepsy, age at seizure onset, kind and number of antiepileptic drugs, were compared between cases and controls. Seizure frequency was higher in SUDEP cases than in controls (P=0.035). Univariate analysis using conditional logistic regression showed that higher seizure frequency (odds ratio [OR]=3.1, P=0.021) and the number of antiepileptic drugs (AEDs) (OR=2.0, P=0.009) were significantly associated with SUDEP. Only the number of AEDs remained significant in multivariate analysis (OR=1.8, P=0.026). Frequent seizures and multi-drug therapy were associated with SUDEP. This may suggest that the severity of epilepsy is associated with SUDEP, regardless of the type of AED used.
Adult ; Age Distribution ; Anticonvulsants/*therapeutic use ; Death, Sudden/*epidemiology/*prevention & control ; Epilepsy/*mortality/*prevention & control ; Female ; Humans ; Incidence ; Male ; Recurrence ; Republic of Korea/epidemiology ; Risk Factors ; Sex Distribution ; Survival Rate ; Young Adult

Neurosyphilis can present with various clinical symptoms. We report a patient with multiple cranial neuropathy that, mimicked tuberculosis, but was finally diagnosed as neurosyphilis. A 38-year-old man was admitted due to subacutely progressive hearing loss. Brain MRI revealed multiple dural enhanced masses on contrast-enhanced T1 weighted images. Brain biopsy of the dural enhanced lesion revealed chronic granulomatous inflammation with coagulation necrosis, compatible with syphilitic gumma. Serum venereal disease research laboratory and fluorescent treponemal antibody absorption test results were positive. Treatment with penicillin resolved the patient's symptom.
Adult ; Biopsy ; Brain ; Cranial Nerve Diseases* ; Fluorescent Treponemal Antibody-Absorption Test ; Hearing Loss ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Necrosis ; Neurosyphilis* ; Penicillins ; Sexually Transmitted Diseases ; Tuberculosis