PURPOSE: The purpose of this study is to evaluate the CT features and pathogenesis of the electric brain injuries. MATERIALS AND METHODS: We reviewed the CT scans of 3 patients injured by high-voltage electricity. We evaluated the findings early and delayed periods in each patients. RESULTS: The early CT findings were diffuse brain edema, scalp swelling, and focal hemorrhagic contusion. The findings of delayed period were cerebral infarction, pneumocephalus, brain abscess, and pneumatocele. CONCLUSION: CT was useful to correlate the pathogenesis and variable features of electric brain injuries.
Brain Abscess ; Brain Edema ; Brain Injuries ; Brain* ; Cerebral Infarction ; Contusions ; Electric Injuries* ; Electricity ; Humans ; Pneumocephalus ; Scalp ; Tomography, X-Ray Computed

Somatostatinoma is rare endocrine tumor that was first described in 1977 by Ganda et al. and Larsson et al. simultaneously. It seems nonfunctioning at clinical level. But it may present with diabetes, diarrhea, cholelithiasis, steatorrhea, indigestion, hypochlorhydria, and anemia. In contrast with pancreatic somatostatinoma, duodenal somatostatinoma, in general, is clinically silent. Duodenal endocrine tumors show similar histologic pattern. Therefore, the definite diagnosis is performed by immunohistochemistry and electron microscopic examination. We have experienced a case of somatostatinoma of duodenum in a 62-year-old male. He has complained generalized pruritus for one year and jaundice for 2 weeks. Grossly, the mass was a intraluminary protruding, polypoid lesion with focal mucosal erosion at immediately distal to Ampulla of Vater. Histologically, it showed tall, cylindrical cells with distinct cell membranes, having granular cytoplasm and small innocent looking nuclei. No mitosis was seen. The tumor cells were arraged in small solid groups and trabeculae, separated by fibrovascular stroma. Immunohistochemically, the tumor cells were strongly positive with somatostatin and negative with several other hormonal and neuroendocrine markers. Ultrastructurally, the cytoplasm contains numerous, homogeneous low electron dense secretory granules, which are essentially similar to those seen in normal delta cells.

PURPOSE: The detection of epileptogenic lesion plays an important role in the management of patients with partial epilepsy. Although the development of MRI improved the examination of cerebral hemispheres greatly, many patients with neocortical temporal lobe epilepsy (TLE) or extratemporal lobe epilepsy (extra-TLE) still show no lesion in conventional two-dimensional (2D) images. To increase the yield of MRI in those patients, we performed three-dimensional (3D) surface-projection rendering (SPR) of the cerebral hemispheres. METHODS: Conventional 2D MRI (T1, T2, FLAIR, thin slice SPGR) and 3D SPR were performed in 24 patients with neocortical TLE and extra-TLE, and 20 normal subjects. Sulcogyral patterns were evaluated blindly to clinical information. The locations of the epileptogenic zone, ictal onset zone (IOZ) and irritative zone (IRZ) were determined by intracranial EEG monitoring and epilepsy surgery. RESULTS: The 2D MRI identified epileptogenic lesions in five of the 10 neocortical TLE (50%) and five of the 14 extra-TLE (35.7%). 3D SPR revealed abnormal sulcogyral patterns in 9 of the 10 neocortical TLE (90%) and 9 of the 14 extra-TLE (64.3%). Cortical deformation zones with sulcogyral anomalies included the whole area of IOZ in 10 (55.5%) and IRZ in 6 (33.3%), overlapped with IOZ in 7 (38.9%) and IRZ in 11 (61.1%), were connected to IOZ in 1 (5.6%) and IRZ in 1 (5.6%). CONCLUSION: 3D SPR of volumetric MRI data can detect epileptogenic structural lesions of neocortical epilepsy that are not visible in the conventional 2D images.
Brain* ; Cerebrum ; Electroencephalography ; Epilepsies, Partial ; Epilepsy* ; Epilepsy, Temporal Lobe ; Humans ; Magnetic Resonance Imaging*

BACKGROUND AND OBJECTIVES: To evaluate the brain MR angiography(MRA) as a tool of diagnosis and follow up study in acute ischemic stroke. METHODS: We reviewed 90 patients of acute ischemic stroke who received thrombolytic therapy and underwent brain MRI with MRA from September 1994 to July 1995. They were divided into two groups according to carotid system and vertebrobasilar system and then positive MRA findings were defined as stenosis or occlusion of vessels in relation with MRI lesions. RESULTS: The positive MRA was shown more than 80% in large arteries and lower than 23% in small arteries. And also the MRA was shown the degree stenosis and underlying vessel abnormalities but could not precisely analyze the degree of improvement of vascular patency in this study. CONCLUSIONS: The MRA as a routine method addition to the MRI provides relatively reliable and noninvasive screening test and provides information that can be more complete evaluation and prognosis in patients of acute ischemic stroke.
Angiography* ; Arteries ; Brain ; Constriction, Pathologic ; Diagnosis ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Mass Screening ; Prognosis* ; Stroke* ; Thrombolytic Therapy ; Vascular Patency

PURPOSE: To investigate the various ictal perfusion patterns and find the relationships between clinical factors and different perfusion patterns. MATERIALS AND METHODS: lnterictal and ictal SPECT and SPECT subtraction were performed in 61 patients with partial epilepsy. Bath positive images showing ictal hypoperfusion and negative images revealing ictal hypoperfusion were obtained by SPECT subtraction. The ictal perfusion patterns of subtracted SPECT were classified into focal hypoperfusion, hypoperfusion-plus, combined hypoperfusion-hypoperfusion, and focal hypoperfusion only. RESULTS: The concordance rates with epileptic focus were 91.8% in combined analysis of ictal hypoperfusion and hypoperfusion images of subtracted SPECT, 85.2% in hypoperfusion images only of subtracted SPECT, and 68.9% in conventional ictal SPECT analysis. Ictal hypoperfusion occurred less frequently in temporal lobe epilepsy (TLE) than extratemporal lobe epilepsy. Mesial temporal hypoperfusion alone was seen only in mesial TLE while lateral temporal hypoperfusion alone was observed only in neocortical TLE. Hippocampal sclerosis had much lower incidence of ictal hypoperfusion than any other pathology. Some patients showed ictal hypoperfusion at epileptic focus with ictal hypoperfusion in the neighboring brain regions where ictal discharges propagated. CONCLUSION: Hypoperfusion as well as hypoperfusion in ictal SPECT should be considered for localizing epileptic focus. Although the mechanisrn of ictal hypopertusion could be an intra-ictal early exhaustion of seizure focus or a steal phenomenon by the propagation of ictal discharges to adjacent brain areas, further study is needed to elucidate it.
Baths ; Brain ; Epilepsies, Partial* ; Epilepsy ; Epilepsy, Temporal Lobe ; Humans ; Incidence ; Pathology ; Perfusion* ; Sclerosis ; Seizures ; Tomography, Emission-Computed, Single-Photon*

Background: Radiotherapy is a common treatment option for lung or esophageal cancer, particularly when surgery is not feasible for patients with poor lung function. However, radiotherapy can affect pulmonary function and thereby induce pneumonitis or pneumonia, which can be fatal in patients with respiratory impairment. The purpose of this study is to evaluate if reductions in pulmonary function after radiotherapy can be minimized through simultaneous pulmonary rehabilitation (PR). Methods: In this matched case control study, we retrospectively analyzed patients who had undergone radiotherapy for thoracic malignant disease between January 2018 and June 2019. We analyzed results from pulmonary function tests and 6-minute walking tests (6MWT) conducted within the six months before and after radiotherapy treatment. Results: In total, results from 144 patients were analyzed, with 11 of the patients receiving PR and radiotherapy simultaneously. Of the 133 patients in the control group, 33 were matched with 11 patients in the PR group. Changes in forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity were significantly different between the PR group and the matched control group (240 mL vs. –10 mL, p=0.017 and 5.5% vs. 1.0%, p=0.038, respectively). The median distance of 6MWT in the PR group also increased significantly, from 407.5 m to 493.0 m after radiotherapy (p=0.017). Conclusion Simultaneous PR improved pulmonary function, particularly in measures of FEV1, and exercise capacity for patients with lung or esophageal cancer even after radiotherapy treatment. These findings may provide an important base of knowledge for further large population studies with long-term follow-up analysis in the identification of the PR’s effects during thoracic radiotherapy.

Alcohol is oxidized to acetaldehyde by alcohol dehydrogenase (ADH) and cytochrome P-4502E1 (CYP2E1), and then to acetate by aldehyde dehydrogenase (ALDH). Polymorphisms of these ethanol-metabolizing enzymes may be associated with inter-individual difference in alcohol metabolism and susceptibility to alcoholic liver disease. We determined genotype and allele frequencies of ALDH2, CYP2E1, ADH2, and ADH3 in male Korean patients with alcoholic cirrhosis (n=56), alcoholics without evidence of liver disease (n=52), and nondrinkers (n=64) by using PCR or PCR-directed mutagenesis followed by restriction enzyme digestion. The prevalences of heterozygous ALDH2*1/*2 plus homozygous ALDH2*2/*2 in patients with alcoholic cirrhosis (7.1%) and alcoholics without evidence of liver disease (3.8%) were significantly lower than that in nondrinkers (45.3%). The c2 allele frequencies of the CYP2E1 in alcoholic cirrhosis, alcoholics without evidence of liver disease, and nondrinkers were 0.21, 0.20, and 0.20, respectively. Allele frequencies of ADH2*2 in the three groups were 0.78, 0.74, and 0.77 and those of ADH3*1 were 0.94, 0.98, and 0.95. Therefore, we confirmed the observation that the ALDH2*2 gene protects against the development of alcoholism. However, the development of cirrhosis in Korean alcoholic patients was not associated with polymorphisms of ethanol-metabolizing enzymes.
Adult ; Alcohol Dehydrogenase/*genetics ; Alcoholism/enzymology/genetics ; Aldehyde Dehydrogenase/*genetics ; Central Nervous System Depressants/pharmacokinetics ; Cytochrome P-450 CYP2E1/*genetics ; Ethanol/pharmacokinetics ; Gene Frequency ; Genetic Predisposition to Disease ; Genotype ; Human ; Korea ; Liver Cirrhosis, Alcoholic/enzymology/*genetics ; Male ; Middle Age ; *Polymorphism (Genetics)

Oral phosphate binders and high calcium dialysate have been used as standard therapies for dialysis patients to prevent renal osteodystrophy. Calcium containing phosphate binders are used to prevent intestinal absorption of dietary phosphate and to avoid aluminum loading by using aluminum containing phosphate binders. The use of calcium products resulted in hypercalcemia in a substantial portion of dialysis population. Calcium carbonate as a phophate binder is widely used in Korea. However, the incidence of hypercalcemia in Korean dialysis patients has not been reported to date. In this study we evaluated the incidence of hypercalcemia in dialysis patients. Patients with associated diseases that may influence serum calcium level were excluded from the study. A total of 180dialysis patients (116 HD patients and 64 CAPD patients) maintained at Soon Chun Hyang University Hospital were included. Three consecutive 2 monthly measurements of serum calcium, phosphate, albumin, alkaline phosphatase, bicarbonate in HD and two consecutive measurements in 3 month interval in CAPD patients were retrospectively evaluated. Ionized calcium and intact parathyroid hormone (N-terminal) were measured every 6 months. Serum total calcium level was corrected by serum albumin level. Three HD patients(2.5%) were hypercalcemic pre-HD while 50(43.1%) hypercalcemic postdialysis. 5 CAPD patients(7.8%) were hypercalcemic. Pre-HD calcium level did not differ from the value in CAPD patients. An average value of pre-and post-HD calcium, and serum albumin levels were significantly higher in HD patients than those values in CAPD patients(p<0.01). Ionized calcium (p<0.01) and serum PTH(p<0.05) levels were significantly higher, while serum bicarbonate level (p<0.01) was significantly lower in HD patients than in CAPD patients. The amount of calcium carbonate used were 2.2g in HD and 2.8g in CAPD. In conclusion, the incidence of hypercalcemia is low in pre-HD (2.5%) and in CAPD patients(7.8%). However, the high incidence of post-HD hypercalcemia observed in this study advocates a future study to evaluate the effect of low calcium dialyste on calcium-phosphate metabolism.
Alkaline Phosphatase ; Aluminum ; Calcium ; Calcium Carbonate ; Dialysis* ; Humans ; Hypercalcemia* ; Incidence* ; Intestinal Absorption ; Korea ; Metabolism ; Parathyroid Hormone ; Peritoneal Dialysis, Continuous Ambulatory* ; Renal Dialysis ; Renal Osteodystrophy ; Retrospective Studies ; Serum Albumin

BACKGROUND: Multiple sclerosis (MS) is a demyelinating disease of the central nervous system. Secondary amyloidosis can occur as a complication of chronic systemic inflammatory and infectious diseases. Until now there has been no report of secondary amyloidosis associated with MS. We report herein a case of renal biopsy-proven secondary amyloidosis in a patient with MS. CASE REPORT: A 41-year-old woman with MS was hospitalized due to aggravated quadriparesis and edema in both lower extremities. Laboratory findings showed nephrotic-range proteinuria and hypoalbuminemia. A percutaneous renal biopsy procedure was performed, the results of which revealed secondary amyloid-A-type amyloidosis associated with MS. CONCLUSIONS: This is the first report of secondary amyloidosis associated with MS.
Adult ; Amyloidosis ; Biopsy ; Central Nervous System ; Communicable Diseases ; Demyelinating Diseases ; Edema ; Female ; Humans ; Hypoalbuminemia ; Lower Extremity ; Multiple Sclerosis ; Nephrotic Syndrome ; Proteinuria ; Quadriplegia

OBJECTIVE: Gynecologic oncologists are uncertain about the safety of tibolone application in cervical adenocarcinoma (AC) patients. This study examined the possible adverse effects of tibolone on the survival of cervical AC patients. METHODS: Medical records of 70 cervical AC patients with International Federation of Gynecology and Obstetrics stages IA to IB were reviewed. A bilateral salpingo-oophorectomy was performed in all patients, and survival outcomes between tibolone users (n=38) and non-users (n=32) were compared. RESULTS: A comparison of the tibolone users with non-users revealed similar clinicopathological variables. Progression-free survival (P=0.34) and overall survival (P=0.22) were similar in the users and non-users. The risks of progression (hazard ratio [HR], 1.71; 95% confidence interval [CI], 0.46–6.37; P=0.43) and death (HR, 1.59; 95% CI, 0.06–45.66; P=0.79) were also similar in both groups. CONCLUSION: Tibolone has no adverse effect on the survival of cervical AC patients and can be administered safely to this population. These findings may be helpful in improving the quality of life of cervical AC patients.
Adenocarcinoma* ; Disease-Free Survival ; Gynecology ; Humans ; Medical Records ; Obstetrics ; Prognosis ; Quality of Life ; Uterine Cervical Neoplasms