Posterior reversible encephalopathy syndrome (PRES) is a transient condition characterized by altered mental status, seizure, headache, and visual disturbance with typical neuro-imaging findings in the bilateral parieto-occipital regions. Clinicians should be aware of this syndrome because delayed diagnosis and treatment result in irreversible neurologic deficits. We present the case of a 77-year-old male diagnosed with PRES in the setting of postoperative critical illness caused by small-bowel strangulation.
Aged ; Critical Illness* ; Delayed Diagnosis ; Headache ; Humans ; Intensive Care Units ; Male ; Neurologic Manifestations ; Posterior Leukoencephalopathy Syndrome* ; Postoperative Period ; Seizures

Gastric neuroendocrine tumor (GNET) is rare, but increasing in incidence. GNET may be classified into three types on the basis of the background pathology. Type I GNET is related to autoimmune atrophic gastritis and hypergastrinemia. Type II is related to multiple endocrine neoplasia (MEN)-1, Zollinger-Ellison syndrome and hypergastrinemia and sporadic Type III is not related to any background pathology. Type I GNETs can be considered as benign tumors with unusual metastases. However, type II may be related to distant metastases, which is also common in type III GNETs. Type I and type II lesions can be treated by endoscopic excision or somatostatin analogues whereas surgical treatment should be considered for type III lesions. Hypergastrinemia is an essential precondition for the evolution of type I and II lesions, but hypergastrinemia alone is not enough for explanation of tumorigenesis. Furthermore, the pathogenesis of type III neuroendocrine tumors is still poorly understood. Despite improvements in our knowledge of GNET pathogenesis in diagnostic approach and treatment, further investigations and large scale clinical studies are warranted.
Cell Transformation, Neoplastic ; Gastritis, Atrophic ; Incidence ; Multiple Endocrine Neoplasia ; Multiple Endocrine Neoplasia Type 1 ; Neoplasm Metastasis ; Neuroendocrine Tumors ; Somatostatin ; Upper Gastrointestinal Tract ; Zollinger-Ellison Syndrome

We report a case of vesical endometriosis in a 34 year old female patient and review literature. Managements include partial cystectomy, hormonal treatment and radiation. In this case, we select the hormonal treatrnent because the vesical endometriosis was in the fixed portion of the bladder.
Adult ; Cystectomy ; Endometriosis* ; Female ; Humans ; Urinary Bladder

Congenital arachnoid cysts are commonly located at sylvian cistern or middle cranial fossa which are usually asymptomatic and incidentally found. Posterior fossa cysts, however, are usually large when diagnosed, and symptomatic. Three cases of large posterior fossa cysts were recognized on the diagnostic MRI investigation for infantile spasm, developmental delay, and the precocious puberty. Surgical decompression of the cysts by craniectomy, cyst excision and fenestration were performed successfully in two patients with arachnoid cysts in the cerebellopontine cistern and the suprasellar, right cerebellopontine, and prepontine cisterns, but an additional cystoperitoneal shunt was needed in a case with the cyst in the quadrigemial cistern with obstructive hydrocephalus. Infantile spasm was treated with vigabatrin and pyridoxine, and the true precocious puberty was managed with LHRH analogue(Decapeptyl ).
Arachnoid Cysts* ; Arachnoid* ; Cranial Fossa, Middle ; Decompression, Surgical ; Gonadotropin-Releasing Hormone ; Humans ; Hydrocephalus ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Puberty, Precocious ; Pyridoxine ; Spasms, Infantile ; Vigabatrin

An endobronchial metastasis is defined as a subsegmental or a more proximal central bronchial metastasis of a nonpulmonary neoplasm in the bronchoscopically visible range. However, the frequencies of endobronchial metastasis range from 2 to 50% of pulmonary metastases from extrathoracic neoplasms by a different difinition of an endobronchial metastasis. Primary neoplasms of an endobronchial metastasis including breast cancer, colon cancer, renal cell carcinoma, and ovarian cancer are relatively common. However, an endobronchial metastasis arising from thyroid cancer, parotid gland tumor, bone tumor, bladder cancer, and stomach cancer has only rarely been reported in the literature. Here we report a case of an endobrochial metastases from a hepatocellular carcinoma
Breast Neoplasms ; Carcinoma, Hepatocellular* ; Carcinoma, Renal Cell ; Colonic Neoplasms ; Neoplasm Metastasis* ; Ovarian Neoplasms ; Parotid Gland ; Stomach Neoplasms ; Thyroid Neoplasms ; Urinary Bladder Neoplasms

BACKGROUND/AIMS: Patients undergoing Billroth II (B II) gastrectomy are at higher risk of perforation during endoscopic retrograde cholangiopancreatography (ERCP). We assessed the success rate and safety of forward-viewing endoscopic biliary intervention in patients with B II gastrectomy. METHODS: A total of 2,280 ERCP procedures were performed in our institution between October 2008 and June 2011. Of these, forward-viewing endoscopic biliary intervention was performed in 46 patients (38 men and 8 women with B II gastrectomy). Wire-guided selective cannulations of the common bile duct using a standard catheter and guide wire were performed in all patients. RESULTS: The success rate of afferent loop entrance was 42 out of 46 patients (91.3%) and of biliary cannulation after the approach of the papilla was 42 out of 42 patients (100%). No serious complications were encountered, except for one case of small perforation due to endoscopic sphincterotomy site injury. CONCLUSIONS: When a biliary endoscopist has less experience and patient volume is low, ERCP with a forward-viewing endoscope is preferred because of its ease and safety in all patients with prior B II gastrectomies. Also, forward-viewing endoscope can be used to improve the success rate of biliary intervention in B II patients.
Catheterization ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Common Bile Duct ; Endoscopes ; Female ; Gastrectomy ; Gastroenterostomy ; Humans ; Male ; Sphincterotomy, Endoscopic

BACKGROUND/AIMS: Gastric cancer is one of the most widespread cancers and the second leading cause of cancer-related death worldwide. Although Helicobacter pylori (H. pylori) has been classified as a type I carcinogen for gastric cancer, the exact pathway has remained indistinct. In this study, we investigated the effects of H. pylori on oncogenic proteins (epidermal growth factor receptor [EGFR], CEA), tumor suppressor (p53) and cell-cycle regulator (p16) expression, using immunohistochemical stains, in gastric neoplasias. MATERIALS AND METHODS: From April 2007 until July 2009, 166 patients with consecutive gastric neoplasias resected were retrospectively enrolled; 35 gastric dysplasias, 70 early gastric cancers and 60 advanced gastric cancers. We examined the relationship of clinicopathologic features of gastric neoplasias such as age, sex, p16, p53, EGFR, tissue CEA, TNM stage, Lauren classification, location, histologic type of neoplasia to H. pylori infection status. RESULTS: H. pylori infection detected in the samples of gastric dysplasia, early gastric cancer (EGC) and advanced gastric cancer (AGC) were 15 (41.7%), 38 (54.3%) and 33 (55.0%) samples. p53, CEA and EGFR stains expression were associated with cancer stage (P<0.05). There was no relation between the immunohistochemical stains (p16, p53, CEA, EGFR) and H. pylori infection. CONCLUSIONS: This study failed to show any relation of immunohistochemical markers of p16, p53, EGFR, CEA expressions to H. pylori infection in gastric dysplasia as well as gastric cancer. Further study is necessary to investigate the effect of H. pylori infection on p16, p53, CEA, EGFR expressions in precancerous lesions such as atrophic gastritis and intestinal metaplasia.
Coloring Agents ; Cyclin-Dependent Kinase Inhibitor p16 ; Gastritis, Atrophic ; Helicobacter ; Helicobacter pylori ; Humans ; Metaplasia ; Proteins ; Retrospective Studies ; Stomach Neoplasms

Primary cardiac tumors are extremely rare and can originate within the heart or be the result of tumor spread from other sites. We report a female patient with a pulmonary vein tumor extending into the left atrium that had a suspicious primary malignant origin with a sacral metastatic carcinoma. The patient was admitted complaining of pain in her buttock area as a result of a sacral tumor. It was believed that the sacral tumor was a metastasis from the imaging study and clinical manifestation. The primary malignant origin was evaluated. The chest CT showed a left atrium thrombus-like lesion without a pulmonary abnormality. After a transesophageal echocardiogram, the patient was diagnosed with a pulmonary vein tumor extending to the left atrium. The patient was given palliative radiotherapy for the sacral pain. Initially, the clinical impression was a metastatic sacral tumor with a thromboembolism of the left atrium. However, this patient was finally diagnosed with a pulmonary vein tumor with a left atrium extension by a transesophageal echocardiogram.
Vascular Neoplasms/*diagnosis/pathology ; Thromboembolism/diagnosis ; Sacrococcygeal Region/pathology ; Pulmonary Veins/*pathology ; Palliative Care ; Humans ; Heart Neoplasms/*diagnosis/pathology ; Heart Atria/*pathology ; Female ; Diagnosis, Differential ; Aged

BACKGROUND/AIMS: Both colorectal neoplasm (CN) and coronary artery obstructive disease (CAOD) are prevalent and major leading causes of death in Korea. Although CN and CAOD share similar risk factors such as male gender, smoking, hyperlipidemia, diabetes mellitus, and obesity, few studies of both CN and CAOD have been reported. In this study, we evaluated clinical correlations between CN and CAOD. METHODS: Between June 2003 and December 2007, 176 patients (Male: 101, average age: 62.1+/-9.7 yr) who underwent colonoscopy after or before coronary angiography were retrospectively enrolled. The colonoscopic findings (normal, adenoma, or cancer) of patients as well as clinical and laboratory data according to the extent of CAOD (normal, minimal CAOD, or CAOD) were compared. RESULTS: CAOD negative, minimal CAOD, and CAOD patients totaled 36, 40, and 100, respectively. The presence of CN (adenoma and adenocarcinoma) in CAOD negative, minimal CAOD, and CAOD cases was 42%, 48%, and 63%, respectively, which was significantly different (P<0.05). In multivariate analysis, old age (> or =60 yr; P=0.03, odds ratio 2.47) and the presence of CAOD (P=0.02, odds ratio 4.11) were associated with the presence of CN. CONCLUSIONS: The prevalence of CN increased in proportion to the severity of CAOD. Colorectal cancer screening by fecal occult blood tests or colonoscopy should be a priority in patients with CAOD, particularly the elderly.
Adenoma ; Aged ; Cause of Death ; Colonoscopy ; Colorectal Neoplasms ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Diabetes Mellitus ; Humans ; Hyperlipidemias ; Korea ; Male ; Mass Screening ; Multivariate Analysis ; Obesity ; Occult Blood ; Odds Ratio ; Prevalence ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking

OBJECTIVES: The aim of this study was to compare the tooth bleaching effect of two whitening materials in toothpaste i.e., hydroxyapatite and hydrogen peroxide on. In a randomized, double blinded controlled clinical trial, 85 participants with tooth colorations were assigned to use one of three toothpastes containing either hydroxyapatite (0.25%), hydrogen peroxide (0.75%), or no active ingredient (placebo). The patients were examined at baseline and 1, 2, and 3 months after usage. METHODS: The patients underwent an oral examination, tooth shade measurement, and a subjective evaluation. During the oral examination, the patient's oral health status was determined. ShadeEye NCC and Vita classical shade guide were used to determine the tooth color. Further, the patients were asked to assess the color of their own teeth using a visual analog scale (VAS) scale (range, 1-5). RESULTS: According to the CIELAB system, a significantly greater color change (Deltab*) was observed in the hydrogen peroxide group (2.10+/-1.54) than in the hydroxyapatite (1.50+/-1.09) and control (0.94+/-0.75) groups after 3 months of toothpaste usage (P<0.002). The DeltaE*color change was not statistically significant among the 3 groups at each time point (P>0.05). The subjective evaluation results of the hydroxyapatite (P=0.023) and hydrogen peroxide (P=0.047) groups were statistically significant at each time point. CONCLUSIONS: The hydrogen peroxide-containing toothpaste caused significant lightening of tooth coloration than the hydroxyapatite and placebo toothpastes.
Diagnosis, Oral ; Durapatite* ; Humans ; Hydrogen Peroxide* ; Hydrogen* ; Oral Health ; Tooth ; Tooth Bleaching ; Toothpastes* ; Visual Analog Scale