PURPOSE: To report a case of visual field defect and optic atrophy in a patient with periventricular leukomalacia. CASE SUMMARY: A 22-year-old woman was referred to our hospital for further glaucoma evaluation. She was diagnosed with normal tension glaucoma by her local ophthalmologist. Best corrected visual acuity and intraocular pressure were 1.0 and 16 mm Hg in both eyes, respectively. Fundus examination showed a cup disc ratio of 0.36 in the right eye and 0.34 in the left eye. However, the optic disc had temporal pallor. Red-free photograph and optical coherence tomography showed supratemporal retinal nerve fiber layer atrophy. Visual field examinations revealed inferior visual field defect in both eyes. The patient was born at 34 weeks of gestation with a birth weight of 1600 g. Brain magnetic resonance imaging (MRI) showed periventricular leukomalacia. CONCLUSIONS: The author presents a case of periventricular leukomalacia with inferior visual field defect and optic atrophy in a patient who was previously diagnosed with glaucoma. If non-specific clinical features that differ from typical glaucomatous clinical features are observed in a patient with a history of prematurity, a brain MRI can aid the diagnosis.
Atrophy ; Birth Weight ; Brain ; Eye ; Female ; Glaucoma ; Humans ; Infant, Newborn ; Intraocular Pressure ; Leukomalacia, Periventricular ; Low Tension Glaucoma ; Magnetic Resonance Imaging ; Nerve Fibers ; Optic Atrophy ; Pallor ; Pregnancy ; Retinaldehyde ; Tomography, Optical Coherence ; Visual Acuity ; Visual Fields

OBJECTIVE: Despite the increasing number of female participation in employment, blue-collar women have been exposed to higher health risk. This study is to describe the prevalence of chronic diseases, health behaviors, and medical service utilization of female blue-collar workers. METHODS: Data were derived from the 2001 Korea National Health and Nutrition Survey (KNHANES). The sample was made up of 37,108 male and female participants aged 20 or over selected nation-wide by probability sampling from Korea. This study applied the logistic regression for nominal variables such as disease prevalence and health behaviors and with the regression for continuos variables such as the length and costs of medical services. RESULTS: In general, women's prevalence of chronic illness and uncured rate were significantly higher than male, and especially female blue-collar workers had the highest prevalence, uncured rate, unhealthy status, and perceived stress. However, the medical care cost was the lowest in female blue-collar workers. CONCLUSIONS: The findings suggest that female blue-collar workers were more likely to experience health problems, and that despite the highest health risk, health service is not effectively utilized, and health policy maker should take consider of special status of female blue collar workers who are in health inequality.
Aged ; Chronic Disease ; Employment ; Female ; Health Behavior ; Health Care Costs ; Health Policy ; Health Services ; Humans ; Korea ; Logistic Models ; Male ; Nutrition Surveys ; Prevalence ; Socioeconomic Factors ; Women's Health

No abstract available.
Splenectomy*

Multiple endocrine neoplasia type 1 (MEN1) syndrome is a relatively rare disease, characterized by the occurrence of multiple endocrine tumors in the parathyroid and pituitary glands as well as the pancreas. Here, we report a case of MEN1 with neuroendocrine tumors (NETs) in the stomach, duodenum, and pancreas. A 53-year-old man visited our hospital to manage gastric NET. Five years prior to his visit, he had undergone surgery for incidental meningioma. His brother had pancreatic nodules and a history of surgery for adrenal adenoma. His brother's daughter also had pancreatic nodules, but had not undergone surgery. The lesion was treated by endoscopic submucosal dissection and diagnosed as a grade 1 NET. Another small NET was detected in the second duodenal portion, resected by endoscopic submucosal dissection, which was also diagnosed as a grade 1 NET. During evaluation, three nodules were detected in the pancreas, and no evidence of pituitary, parathyroid tumors, or metastasis was observed. After surgery, the pancreatic lesions were diagnosed as NETs, with the same immunohistochemical patterns as those of the stomach and duodenum. Genetic testing was performed, and a heterozygous mutation was detected in the MEN1 gene, which is located on 11q13.
Adenoma ; Duodenum* ; Endoscopy ; Genetic Testing ; Germ-Line Mutation ; Humans ; INDEL Mutation ; Meningioma ; Middle Aged ; Multiple Endocrine Neoplasia Type 1* ; Neoplasm Metastasis ; Neuroendocrine Tumors* ; Nuclear Family ; Pancreas* ; Pituitary Gland ; Rare Diseases ; Siblings ; Stomach*

Bougie or balloon dilation is a good short-term treatment for caustic esophageal strictures, although recurrence after dilation occurs in approximately 30% of these cases. Therefore, long-term treatment options are required in some cases, and endoscopic incisional therapy has been used for patients with an anastomotic stricture in the gastrointestinal tract. A 58-year-old woman presented with severe swallowing difficulty because of a caustic esophageal stricture, which was caused by accidental exposure to anhydrous acetic acid at infancy. She had undergone several previous bougie and balloon dilations but the stricture did not improve. We performed sequential treatment comprising incision with an insulated-tip knife, balloon dilation, and an oral steroid, which resulted in the patient’s symptoms markedly improving. Thus, we report this case of an intractable caustic esophageal stricture, which was successfully treated using combined endoscopic sequential treatment.
Acetic Acid ; Caustics ; Constriction, Pathologic ; Deglutition ; Deglutition Disorders ; Dilatation ; Esophageal Stenosis* ; Female ; Gastrointestinal Tract ; Humans ; Middle Aged ; Recurrence

PURPOSE: A sensitive assay to detect minimal residual disease (MRD) in neuroblastoma (NBL) is necessary for accurate assessment of disease status and optimal treatment. Reverse transcriptase-polymerase chain reaction (RT-PCR) for tyrosine hydroxylase (TH) mRNA was developed to detect minimal residual NBL cells. METHODS: Thirteen patients with stage I to IV NBL and one healthy donor were included in this study. Samples for bone marrow (BM) and peripheral blood (PB) were obtained at diagnosis, during treatment, and during follow-up after completion of treatment, and were examined for TH mRNA with RT-PCR. RESULTS: TH mRNA was detected in NBL cell line and cells obtained from BM with cytologic tumor invasion, but was not detected in normal PB mononuclear cells (MNC). Occult NBL cells were detected at a level of 1 for 105~6 normal PB MNC by this method. TH mRNA was detected in 13 of 28 BM or PB samples. TH mRNA came to be not detected after administration of chemotherapeutic agent. TH mRNA was detected in 1 PB sample harvested for transplantation and was detected in 2 of 5 PB samples obtained from patients who were transplanted with autologous PB stem cells in partial response (PR) state. TH mRNA was not detected in patient transplanted in complete response (CR) state. In recent examinations, TH mRNA was detected in 1 of 7 CRs and in 2 of 6 PRs. CONCLUSION: RT-PCR for TH mRNA was a sensitive method to detect minimal residual NBL cells. This method can be used to evaluate initial disease status, response to treatment, time to collect stem cells for transplantation, suitability of cellected stem/progenitor cells and to detect relapse early. But the clinical significances of TH mRNA detected by this method require further investigation.
Bone Marrow ; Cell Line ; Diagnosis ; Follow-Up Studies ; Humans ; Neoplasm, Residual ; Neuroblastoma* ; Recurrence ; RNA, Messenger* ; Stem Cells ; Time-to-Treatment ; Tissue Donors ; Transplantation ; Tyrosine 3-Monooxygenase* ; Tyrosine*

While esophagogastric varices are common manifestations of portal hypertension, variceal bleeding from the jejunum is a rare complication of liver cirrhosis. In addition, ectopic variceal bleeding occurs in the duodenum and at sites of previous bowel surgery in most cases, including of stomas. We report a case of obscure overt gastrointestinal bleeding from jejunal varices in a 55-year-old woman who had not previously undergone abdominal surgery, who had liver cirrhosis induced by the hepatitis C virus. Emergency endoscopy revealed the presence of esophageal varices without stigmata of recent bleeding, and no bleeding focus was found at colonoscopy. She continued to produce recurrent melena with hematochezia and received up to 21 units of packed red blood cells. CT angiography revealed the presence of jejunal varices, but no active bleeding was found. Capsule endoscopy revealed fresh blood in the jejunum. The patient submitted to embolization of the jejunal varices via the portal vein, after which she had a stable hemoglobin level and no recurrence of the melena. This is a case of variceal bleeding from the jejunum in a liver cirrhosis patient without a prior history of abdominal surgery.
Angiography ; Capsule Endoscopy ; Embolization, Therapeutic ; Esophageal and Gastric Varices/complications/diagnosis ; Female ; *Gastrointestinal Hemorrhage ; Humans ; Hypertension, Portal ; Jejunal Diseases/*diagnosis/therapy ; Liver Cirrhosis/*diagnosis ; Melena/complications ; Middle Aged ; Tomography, X-Ray Computed

Zollinger-Ellison syndrome (ZES) is characterized by gastrinoma and resultant hypergastrinemia, which leads to recurrent peptic ulcers. Because gastrinoma is the most common pancreatic endocrine tumor seen in multiple endocrine neoplasia type I (MEN 1), the possibility of gastrinoma should be investigated carefully when patients exhibit symptoms associated with hormonal changes. Ureteral stones associated with hyperparathyroidism in the early course of MEN 1 are known to be its most common clinical manifestation; appropriate evaluation and close follow-up of patients with hypercalcemic urolithiasis can lead to an early diagnosis of gastrinoma. We report a patient with ZES associated with MEN 1, and urolithiasis as the presenting entity. A 51-year-old man visited the emergency department with recurrent epigastric pain. He had a history of calcium urinary stone 3 years ago, and 2 years later he had 2 operations for multiple jejunal ulcer perforations; these surgeries were 9 months apart. He was taking intermittent courses of antiulcer medication. Multiple peripancreatic nodular masses, a hepatic metastasis, parathyroid hyperplasia, and a pituitary microadenoma were confirmed by multimodal imaging studies. We diagnosed ZES with MEN 1 and performed sequential surgical excision of the gastrinomas and the parathyroid adenoma. The patient received octreotide injection therapy and close follow-up.
Gastrinoma/metabolism/pathology/ultrasonography ; Gastrins/metabolism ; Humans ; Immunohistochemistry ; Liver/radiography ; Magnetic Resonance Imaging ; Male ; Mesenteric Artery, Superior/radiography ; Middle Aged ; Multimodal Imaging ; Multiple Endocrine Neoplasia Type 1/complications/*diagnosis/radiography ; Pancreas/radiography/radionuclide imaging ; Pituitary Gland/radiography ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Thyroid Gland/ultrasonography ; Tomography, X-Ray Computed ; Urolithiasis/*diagnosis/etiology ; Zollinger-Ellison Syndrome/complications/*diagnosis

Intraocular (IO) retinoblastoma (RB) has traditionally been treated with enucleation (ENU) or external beam radiotherapy (EBRT). Recently, clinical trials are in progress to cure RB without ENU or EBRT in order to salvage the globe and to avoid unacceptable side effects of EBRT. We performed a pilot study to treat patients with advanced Reese-Ellsworth (RE) stage IO RB with initial chemotherapy (CRx) followed by local therapy (LT) and adjuvant CRx. Ten eyes (8 RE group V, 2 RE group IV) from 9 patients were enrolled from March 2001 to November 2001. All tumors responded to CRx. In 5 of 10 eyes, the RB was enough to be treated with LT after chemoreduction. One patient who underwent LT is waiting for ENU due to post-cryotherapy complication. For a median follow-up of 13 months (8-16 mo), 4 eyes that received LT and adjuvant CRx were relapse-free. A patient with bilateral RB who failed to be a candidate for LT was rescued with high-dose CRx and hematopoietic stem cell transplantation. Consequently, by treating patients according to our strategy, we were able to salvage 6 out of 10 eyes without ENU or EBRT. These results suggest that chemoreduction followed by LT and adjuvant CRx might offer the opportunity to salvage the globe and vision even in patients with advanced stage IO RB.
Antineoplastic Combined Chemotherapy Protocols/administration & dosage/therapeutic use ; *Chemotherapy, Adjuvant ; Child, Preschool ; Cyclophosphamide/therapeutic use ; Epirubicin/therapeutic use ; Female ; Humans ; Infant ; Male ; Pilot Projects ; Retinal Neoplasms/*drug therapy ; Retinoblastoma/*drug therapy ; Time Factors ; Vincristine/therapeutic use

Albendazole binds to parasite's tubulin inhibiting its glucose absorption. Its common adverse effects are nausea, vomiting, constipation, thirst, dizziness, headache, hair loss and pruritus. Although mainly metabolized in the liver, abnormal liver function tests were a rare adverse effect during clinical trials and we found no literature about albendazole-induced hepatitis requiring admission. This patient had a previous history of albendazole ingestion in 2002 resulting in increase of liver function tests. And in 2005, the episode repeated. We evaluated the patient for viral hepatitis, alcoholic liver disease, and autoimmune hepatitis, but no other cause of hepatic injury could be found. Liver biopsy showed periportal steatosis and periportal necrosis. The initial abnormal liver function test improved only with supportive care. These findings and the Roussel Uclaf Causality Assessment Method of the Council for International Organizations of Medical Sciences (RUCAM/CIOMS) score of 9 are compatible with drug-induced hepatitis so we report the case of this patient with a review of the literature.
Albendazole/*adverse effects ; Antiprotozoal Agents/*adverse effects ; Eosinophils/metabolism ; Glucose/metabolism ; Hepatitis, Toxic/*diagnosis ; Humans ; Liver/drug effects ; Liver Function Tests ; Male ; Middle Aged ; Necrosis