BACKGROUND AND OBJECTIVES: We aimed to analyze the morphologic features of the nose in the human embryo from 4th to 8th developmental weeks according to the Carnegie stage. MATERIALS AND METHOD: A total of 27 cases of embryos, ranging from Carnegie stage of 13 to 23, were analyzed. The external morphology was observed with a stereomicroscope, photographed and analyzed. The histologic features were observed with a light microscope in the horizontally-transected specimens stained with hematoxylin-eosin staining. RESULTS: The nasal placode was observed at the stage 13, and it became flat or even concave at the stage 14. At the stage 15, the nasal pit was formed. At the stage 16, the nasal sac and nasal fin were observed. At the stage 17, the oronasal membrane was formed by thinning of the nasal fin. At the stage 18, the primitive choana was established by rupture of the oronasal membrane. At the stage 19, the lateral palatine process projected vertically below the level of the tongue. The cartilaginous nasal capsule was formed at the stage 20. At the stage 21, the olfactory area was localized to the upper portion of the lateral nasal wall and the nasal septum. At the stage 22, the lateral palatine process developed in a somewhat horizontal orientation. At the stage 23, the premaxilla and primitive choana were formed. CONCLUSION: The development of the nose is most active from the Carnegie stage of 13 to 19, which corresponds to the end of the 4th embryonic week to the end of the 7th week. Thus, this period is considered to be the most important period in human nasal embryonic development.
Embryonic Development ; Embryonic Structures* ; Female ; Humans* ; Membranes ; Nasal Septum ; Nose* ; Pregnancy ; Rupture ; Tongue

Cerebral gigantism(Sotos syndrome) is a growth disorder that consists of large size at birth, rapid early growth rate with accompanying advanced bone age, acromegalic features, and developmental delay. Clumsiness in the absence of other abnormal neurologic findings is common. The cause is unknown. We report here a case of 238/12-year-old Sotos syndrome with final adult height above 97 percentile, abnormal brain MRI findings(large ventricles, prominent trigone, prominent occipital horn & thining of corpus callosum), clumsiness, and some behavioral problems.
Adult ; Animals ; Brain ; Growth Disorders ; Horns ; Humans ; Magnetic Resonance Imaging ; Neurologic Manifestations ; Parturition ; Sotos Syndrome

OBJECTIVE: The intracranial pathologies after head trauma should be usually progressed. It is clearly visualized in the non-invasive brain CT. The invasive monitor such as intracranial pressure (ICP) monitoring may be accompanied with the complications. This study aims whether the patients with severe head injury could be managed with serial CT scans. METHODS: The medical records of 113 patients with severe head injury in the prospectively enrolled trauma bank were retrospectively analyzed. After the emergency care, all the patients were admitted to the intensive care unit for the aggressive medical managements. Repeat brain CT scans were routinely taken at 6 hours and 48 hours after the trauma. ICP monitoring was restrictively applied for the uncertain intracranial pressure based on the CT. The surgical intervention and the mortality rate were analyzed. RESULTS: Immediate surgical intervention after the initial CT scan was done in 47 patients. Among the initially non-surgical patients, 59 patients were managed with the serial CT scans and 7 with the ICP monitoring. Surgical interventions underwent eventually for 10 patients in the initially non-surgical patients; 1 in the ICP monitoring and 9 in the serial CT. The mortality rate was 23.7% in the serial brain CT and 28.6% in the ICP monitoring. There was no statistical difference between two groups in the aspect of mortality (p=0.33). CONCLUSION: Serial CT scans in time could be a good way to monitor the intracranial progression in the severe head injury and reduce the implantation of an invasive ICP probe.
Brain* ; Craniocerebral Trauma* ; Emergency Medical Services ; Humans ; Intensive Care Units ; Intracranial Pressure* ; Medical Records ; Mortality ; Pathology ; Prospective Studies ; Retrospective Studies ; Tomography, X-Ray Computed*

Setleis syndrome, also known as the focal facial dermal dysplasia type 3, is characterized by atrophic scar-like lesions in both the temporal regions and other facial abnormalities. The syndrome is associated with a mutation in the TWIST2 gene and is inherited as an autosomal recessive pattern. Here, we describe a case of an 18-year-old woman and her 10-year-old brother with bitemporal depressed patches. The lesions were observed at birth, but they were replaced by atrophic patches after several months. No abnormalities in growth or development were observed. Histopathologic findings showed atrophy of the epidermis and loss of appendages, such as hair follicles and adnexal glands, in the atrophic patches compared to that of the adjacent normal skin.

Primary aldosteronism is defined as hypertension, hypokalemia, increased serum aldosteron, decreased serum renin activity. It has been known that prolonged hypokalemia, renal cyst formation and impairment of renal function. However, nephrocalcinosis associated with primary aldosteronism is rarely reported. A 31-year-old male was admitted to our hospital because of abdominal pain and uncontrolled hypertention which developed 2 years earlier. At admission, blood pressure 180/100 mmHg. Biochemical findings indicated sodium 146 mEq/L, potassium 2.3 mEq/L, BUN 8.2 mg/dL, creatinine 1.1 mg/dL, calcium 10.7 mg/dL, phosphate 5.7 mg/dL, magnesium 1.8 mg/dL. Twenty-four hour urine collection indicated sodium 108 mEq, potassium 32 mEq, calcium 75 mg, phosphate 72 mg, magnesium 8.0 mg. The hormone study revealed PTH 22.7 pg/mL (normal: 9~55 pg/mL), ACTH 8 pg/mL (normal: 6~56.7 pg/mL), aldosterone 51.0 ng/dL (normal: 1~16 ng/dL), plasma renin activity below 0.01 ng/mL/hr (normal: 0.15~233 ng/mL/hr). Abdominal sonography showed homogenous increased medullary echoes and multiple calcification. The abdomen CT showed adrenal mass (1 x 1 cm) consistent with adrenal tumor. Adrenalrectomy was performed on the 16th hospital day and clinical symptoms, blood pressure and hypokalemia improved shortly after operation.
Abdomen ; Abdominal Pain ; Adrenocorticotropic Hormone ; Adult ; Aldosterone ; Blood Pressure ; Calcium ; Creatinine ; Humans ; Hyperaldosteronism* ; Hypertension ; Hypokalemia ; Magnesium ; Male ; Nephrocalcinosis* ; Plasma ; Potassium ; Renin ; Sodium ; Urine Specimen Collection

STUDY DESIGN: The authors retrospectively analysed the recovery of clinical symptoms after surgical treatment of lumbar HIVD. OBJECTIVES: To investigate the incidence of clinical symptoms, the recovery rate and time after surgical treatment and the difference between L4-5 and L5-S1 lesion. SUMMARY OF LITERATURE REVIEW: There are many reports concerning the clinical result of surgical treatment for the HIVD. They usually describe the result as excellent, good, fair and poor. We can't get any information about the recovery rate and recovery time of each clinical symptom from the reports . MATERIALS AND METHODS: Thirty-eight patients were treated by one level open discectomy from march 1991 to december 1995, The clinical symptoms and signs including SLR, motor deficit, sensory deficit, change of DTR and severity of radiating pain were periodically followed up on the predesigned protocol. RESULTS: In preoperative examination, SLR was positive in 82%, motor deficit in 76%, sensory deficit in 74%, DTR change in 50%, and radiating pain in 100%. The recovery rate of SLR was 96.8%, motor deficit ; 93.6%, sensory deficit ,78.6%, DTR change ; 21% and radiating pain ,84.2%. The average recovery time of SLR was 3.4 months, motor deficit ; 1.9 months, sensory deficit ; 5.3 months, DTR change ; 4.1 months and radiating pain ; 3.2 months. Motor and sensory deficit was more frequent in L4-5 lesion but DTR change was usually noted in L5-S1 lesion. The recovery rate and time showed no great difference between the two level. CONCLUSIONS: The recovery rate was higher in SLR, motor deficit and radiating pain rather than sensory deficit and DTR change. The recovery time was fastest in radiating pain but variable nature was noted in sensory deficit. Above results may be helpful to explain the prognosis of the lumbar HIVD.
Diskectomy ; Humans ; Incidence ; Prognosis ; Retrospective Studies

To find out the different cognition of the members of medical school about the importance of graduate outcomes such as 'clinical performance, communication, supporting patients, professionalism, problem solving and research, self-development', a survey applied with self-report method was conducted with 110 faculties, 132 students (71 premedical 2nd graders and 61 medical 2nd graders), and 30 parents about graduate outcomes and sub-outcome competences. Parents usually thought highly of the importance of graduate outcomes, while medical second graders comparatively regarded them as less important. Among graduate outcomes, 'clinical performance' was definitely considered the most important and was followed by 'communication'. As for 'self-development', parents and premedical 2nd graders regarded it as important, while faculty and medical 2nd graders had lower awareness about its importance. As to the suboutcome competences, faculty generally had lower awareness about their importance compared to students and parents.
Cognition ; Humans ; Methods ; Parents* ; Problem Solving ; Professionalism ; Schools, Medical*

Marchiafava-Bignami disease(MBD), characterized by the primary degeneration of the corpus callosum, is a rare complication of chronic alcoholism. Recently, a few cases of MBD with reversible neuro-imaging abnormalities were reported. A 58-year-old, chronic alcoholic man was admitted with mental change, dysarthria, and a seizure attack. A T2-weighted Brain magnetic resonance imaging demonstrated high signal intensities in the body and splenium of the corpus callosum, multiple white matter, and cortical gray matter. Treatment with a multiple vitamin complex resulted in a near complete recovery of neurological manifestation. A brain MRI obtained four weeks after admission revealed a dramatic resolution of previous imaging abnormalities. We report a case of Marchiafava-Bignami disease with reversible neuro-imaging abnormalities.
Alcoholics ; Alcoholism ; Brain* ; Corpus Callosum ; Dysarthria ; Humans ; Magnetic Resonance Imaging* ; Marchiafava-Bignami Disease* ; Middle Aged ; Neurologic Manifestations ; Seizures ; Vitamins

Primary small cell cancer of the duodenum is very rare. Only six cases have been reported previously. The patient of this case report was a twenty-year-old male who suffered from frequent nausea and vomiting being accompanied by weight loss. The poorly differentiated neuroendocrine cancer was initially diagnosed by endoscopic biopsy and the patient underwent pancreaticoduodenectomy. The diagnosis was refined as primary small-cell neuroendocrine cancer of which the histological appearance was identical to pulmonary and extrapulmonary small-cell carcinoma. The neuroendocrine differentiation was demonstrated by the positive immunoreactions for neuron-specific enolase. This case emphasizes the need to include the duodenum as a possible primary site when metastatic small cell neuroendocrine carcinoma is seen in the absence of apparent pulmonary disease.
Biopsy ; Carcinoma, Neuroendocrine ; Diagnosis ; Duodenal Neoplasms* ; Duodenum ; Humans ; Lung Diseases ; Male ; Nausea ; Pancreaticoduodenectomy ; Phosphopyruvate Hydratase ; Vomiting ; Weight Loss

OBJECTIVE: Most cases of spontaneous subarachnoid haemorrhage (SAH) are due to a ruptured cerebral aneurysm, yet sometimes the cause of bleeding can be obscure. We report here on the results of a retrospective single-center study to determine the role of the hemorrhage patterns for the patients with a negative angiogram on admission. METHODS : A total of 480 patients with spontaneous subarachnoid hemorrhage (SAH) were admitted from January 2004 to September 2008. Of these, 44 patients were included in this study because of their negative findings on their initial angiography. SAH was diagnosed by a computed tomographic scan or lumbar puncture. The clinical grade was assessed using the Hunt-Hess grading system, Fisher's grading system and the modified Rankin scale. RESULT : The overall incidence of an initially negative angiogram for patients with a spontaneous SAH was 10.2%. Based on the hemorrhage pattern on the admission CT, the most common pattern was the diffuse type (52.3%), followed by the perimesencephalic type (29.5%), the CT negative type (11.4%) and the localized non-perimesencephalic type (6.8%). The repeat angiogram revealed an aneurysm in 3 (7.7%) patients and exploration revealed a dissecting aneruysm of the vertebral artery in 1 patient. The patients with the diffuse type SAH significantly differed from the perimesencephalic group with regard to the Fisher grade (p = 0.002), the outcome at discharge (p = 0.004) and the need for EVD. CONCLUSION : Patients with SAH of an unknown cause, especially with perimesencephalic SAH, have an excellent prognosis and low mortality. We believe that digital subtraction angiogram is still the gold standard for making the diagnosis of aneurysm in patients with spontaneous SAH. A repeat angiogram is recommended for all the patients with initially angionegative SAH. For those patients with perimesencephalic SAH and a positive CSF study with a negative CT, we suggest to perform a CT angiogram as a less invasive follow-up study.
Aneurysm ; Angiography ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Intracranial Aneurysm ; Prognosis ; Retrospective Studies ; Spinal Puncture ; Subarachnoid Hemorrhage ; Vertebral Artery