Pagonimus Westmani, occuring as an important human infestation of the lung, is widely distributed in the Far East ; Korea, Japan, China and the Philippines. Since Otani found the parasites for the first time in the human brain in 1887, it has been established that cerebral infestation occurs with the highest frequency among extrapulmonary involvement. In 0.8 to 25 percent of patients infested with the lung flukes cerebral paragonimiasis may be developed. The larvae may procedure arachnoiditis, abscess, fibrous cystic lesions and granulomas in the brain. Based on a review of the literatures and upon the 7 cases of cerebral paragonimiasis which have been observed by the authors at the National Medical Center, Seoul, Korea, the following points are stressed. 1) Males had a significantly higher prevalence than females. Cerebral paragonimiasis was most commonly found in young adults(16 to 25yrs). 2) Clinically the patients with cerebral involvement were characterized by Jacksonian type of epilepsy, headache and visual disturbance. Mental deterioration, hemiplegia, hemihypesthesia, homonymous hemianopsia and optic atrophy were the five major signs. 3) The patients having symptoms for less than 6 months developed mild leukocytosis in many cases. All the cases of cerebral paragonimiasis revealed positive reaction in the intradermal tests with purified antigens of P. Westermani. 4) On skull films multiple round or oval cystic calcification was diagnostic value for cerebral paragonimiasis. On angiogram vascular staining and abnormal vessels were not disclosed. On pneumoencephalogram subcortical atrophy or filling defect of the ventricle may be showed. 5) The predilection area of the granuloma and fibrous cystic mass were the occipital, posterior parietal and posterior temporal lobes. 6) The patients with chronic stabilized cerebral paragonimiasis. having intractable symptoms and signs, could not be improved with Bithionol treatment. But headache, vomiting, visual disturbance, facial weakness and especially intractable seizure were improved in our cases treated with surgical operation.
Abscess ; Arachnoid ; Arachnoiditis ; Atrophy ; Bithionol ; Brain ; China ; Epilepsy ; Far East ; Female ; Granuloma ; Headache ; Hemianopsia ; Hemiplegia ; Humans ; Intradermal Tests ; Japan ; Korea ; Larva ; Leukocytosis ; Lung ; Male ; Optic Atrophy ; Paragonimiasis* ; Parasites ; Philippines ; Prevalence ; Rabeprazole ; Seizures ; Seoul ; Skull ; Temporal Lobe ; Trematoda ; Vomiting

Parathyroid cancer is a rare disease, of which about 700 cases have been reported since first being described by de Quevain in 1904. In particular, multiple primary parathyroid cancer is extremely rare and to our knowledge only 4 cases have been reported in the literature since the first report in 1990. A 41-year-old male patient was presented with bilateral neck mass, polydypsia and polyuria with hypercalcemia and high parathyroid hormone level. The patient underwent surgery at Kosin University Gospel Hospital and was diagnosed as double parathyroid cancer on pathologic examination. So, we report this rare case with literature.
Adult ; Humans ; Hypercalcemia ; Male ; Neck ; Parathyroid Hormone ; Parathyroid Neoplasms* ; Polyuria ; Rare Diseases

BACKGROUND AND OBJECTIVES: Voice quality may be an important issue for choosing treatment options of early glottic cancer. It has been reported that voice quality is worse after laser cordectomy compared to that of radiation therapy. But, with developed visualization tools, the precise localization of lesions became possible enabling surgeons to decide the appropriate surgical extent to preserve voice after laser cordectomy. The authors assessed the postoperative voice quality of patients who underwent laser cordectomy according to the classification by the European Laryngological Society. SUBJECTS AND METHOD: Thirty patients who were diagnosed with glottic cancer and treated with laser cordectomy between April, 1999 and January, 2006, were evaluated. All the patients were followed-up more than 6 months. Objective evaluations included maximal phonation time, fundamental frequency, jitter, shimmer, noise-to-harmonics ratio and subjective evaluation was performed by the GRBAS scale. RESULTS: The type II laser cordectomy group and some cases of the type III cordectomy showed no significant differences compared with the normal control group in both objective and subjective evaluations. CONCLUSION: This study shows that the group of laser cordectomy type II and some cases of type III had acceptable results compared to that of the normal control group. Thus, laser cordectomy could be considered as an alternative to radiation therapy in selected patients with early glottic cancer, even when preserving the quality of voice is an important issue.
Humans ; Phonation ; Voice ; Voice Quality

Warthin's tumor is the second most common benign tumor of the parotid gland. Malignancy arising from Warthin's tumor is extremely rare, and only 29 cases have been reported. Diagnosis can be made prior to the surgery, but in many cases, the disease is detected through postoperative pathology report or by recurrence of the mass lesion. We report a case of polymorphous low grade adenocarcinoma arising from Warthin's tumor diagnosed by the excision of a parotid mass and treated by an additional surgery of superficial parotidectomy. The postoperative pathology report revealed no residual cancer cells and the patient is free of disease for 8 months since the operation.
Adenocarcinoma* ; Adenolymphoma ; Diagnosis ; Humans ; Neoplasm, Residual ; Parotid Gland ; Pathology ; Recurrence

Acute renal infarction usually occurs in patients with trauma, atrial fibrillation, atherosclerosis, vasculitis, and valvular heart disease. However, it may occur, though rarely, in patients with hypercoagulable states such as protein C and protein S deficiency. We report here a case of acute bilateral renal infarction associated with type II protein S deficiency without a demonstrable underlying cause. A 48-year-old male was presented to the emergency room with an abrupt, persistent pain at the left flank area. Three-dimensional abdominal computed tomography revealed wedge-shaped, well demarcated, low density lesions in both the kidneys, which were consistent with occlusions of segmental branches of both the renal arteries. Protein S activity by clot-based assay was 43% (73.7-146.3%). The patient was treated with intravenous heparin and later warfarin. He has remained symptom-free on warfarin therapy with preserved renal function during the follow-up of 5 weeks.
Atherosclerosis ; Atrial Fibrillation ; Emergencies ; Follow-Up Studies ; Heart Valve Diseases ; Heparin ; Humans ; Infarction ; Kidney ; Male ; Middle Aged ; Protein C ; Protein S ; Protein S Deficiency ; Renal Artery ; Vasculitis ; Warfarin

BACKGROUND AND OBJECTIVES: Salvage surgery for recurrent glottic cancer after radiation failure has been reported in the literature as a treatment for total laryngectomy and partial laryngectomy (vertical partial laryngectomy, supracriocoid partial laryngectomy) in selected cases. Also, CO2 laser cordectomy has also been reported as a successful primary treatment for early glottic cancer. However, salvage laser surgery for recurrent glottic cancer has been rarely reported. Our experience of transoral laser cordectomy on recurrent glottic cancer after radiotherapy is reported. SUBJECTS AND METHOD: Twelve patients with early recurrent glottic cancer after full-course radiotherapy (rT1a, n=4 ; rT1b, n=1 ; rT2, n=7) underwent laser cordectomy between October, 2002 and January, 2005. According to the European Laryngological Society Classification, they were found to have two type III, one type IV, and eight type V performed. One patient underwent type II at one side and type III at the other. Surgery in all the cases were performed at one stage with curative intent. RESULTS: The mean follow-up interval was 30 months (range 17-44 months) with five out of 12 cases (42%) having local recurrence. Four of the five cases with local recurrence underwent total laryngectomy. Three cases were salvaged while one had additional recurrence. The other one was under palliative treatment. The local control rate was 58%, overall survival and disease specific survival rate was 100%. The mean hospitalized period was 6.4 days (range 2-26 days) after surgery, and tracheotomy was performed in four cases (duration : 3-20 days). There was no postoperative aspiration pneumonia and nasogastric tube was not performed in any of the cases. CONCLUSION: Transoral laser microsurgery may be a feasible salvage method for recurrent glottic cancer to gain oncologic and functional results, and could be used as an organpreserving procedure with curative intent in selected cases.
Classification ; Follow-Up Studies ; Humans ; Laryngeal Neoplasms ; Laryngectomy ; Laser Therapy ; Lasers, Gas ; Microsurgery ; Palliative Care ; Pneumonia, Aspiration ; Radiotherapy* ; Recurrence ; Survival Rate ; Tracheotomy

BACKGROUND/AIMS: Twenty-four-hour ambulatory esophageal pH monitoring is considered the gold standard for diagnosing gastroesophageal reflux disease. The aim of this study was to quantify normal distal esophageal acid parameters in healthy Koreans. METHODS: Thirty healthy adults who were not on medication and were free from gastrointestinal symptoms were analyzed. Ambulatory esophageal acid (pH <4) exposure parameters were recorded at 5 cm above the lower esophageal sphincter. RESULTS: The 95th percentiles for reflux parameters assessed in the distal esophagus were as follows: percentage of total time with pH <4, 5.10%; percentage of upright time with pH <4, 7.88%; percentage of supine time with pH <4, 4.00%; number of reflux episodes, 62.7; number of reflux episodes with pH <4 for >5 minutes, 5.3; and the longest single acid-exposure episode, 21.3 minutes. CONCLUSIONS: Physiological gastroesophageal reflux occurs frequently in healthy Koreans. These data provide a reference range that could be utilized in studies involving Korean subjects.
Adult ; Esophageal pH Monitoring ; Esophageal Sphincter, Lower ; Esophagus ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Reference Values

BACKGROUND AND OBJECTIVES: Hereditary medullary thyroid carcinoma is presented as a part of MEN2A (65-75%) or MEN2B, but can also be inherited alone, which is called familial medullary thyroid carcinoma. The author sought to detect point mutations of the RET proto-oncogene using the molecular genetic method on the family line of the familial medullary thyroid carcinoma, which is identified by the family history of an index patient, and to investigate the presence of point mutation carriers among the family members. SUBJECTS AND METHOD: DNA was extracted from the peripheral blood leukocyte of 5 patients who were assumed to have sporadic medullary thyroid carcinoma and 1 patient who was an index of a family line assumed to contain hereditary medullary thyroid carcinoma according to the family history. The PCR amplification of exons, 10, 11, 13, 14, 15, 16 was then carried out, and we investigated point mutations of the RET proto-oncogene using a DNA sequence analyzer. After identifying point mutation of the familial medullary carcinoma with them, the same investigation was carried out with their family. RESULTS: We identified point mutation of TGC (Cys)->CGC (Arg) at codon 618 of the RET proto-oncogene exon 10, using the automatic DNA sequence analyzing method on the index patient and detected the same point mutation with 4 of the 9 family members. Among them, the index patient and her mother who had biochemical and clinical symptoms underwent a total thyroidectomy and neck dissection and are now being followed up ; operations are scheduled for two other members later on. CONCLUSION: With the genetic analysis of RET proto-oncogene, we expect to overcome the limitations of the calcitonin stimulation test and that more complete approach through early diagnosis would be possible by carrying out the screening test for point mutation in patients with the hereditary medullary thyroid carcinoma.
Base Sequence ; Calcitonin ; Carcinoma, Medullary ; Codon ; DNA ; Early Diagnosis ; Exons ; Humans ; Leukocytes ; Mass Screening ; Molecular Biology ; Mothers ; Multiple Endocrine Neoplasia Type 2a ; Multiple Endocrine Neoplasia Type 2b ; Neck Dissection ; Point Mutation* ; Polymerase Chain Reaction ; Proto-Oncogenes ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

BACKGROUND AND OBJECTIVES: MEN I is an autosomal dominant disorder characterized by multiple tumors occurring in the parathyroid, pituitary, and pancreas. There is a variety of mutations in MEN I that are scattered throughout the coding region, thus MEN I family has its unique type of mutations. The aim of this study is to investigate the significance of genetic screening via analyzing the MEN I gene in the MEN I family. SUBJECTS AND METHOD: Three family members related to MEN I were involved for studying the MEN I gene mutation by using single strand conformational polymorphism and DNA sequence analysis of the coding region and the exon-intron boundaries of the MEN I gene. RESULTS: A specific germline mutation of 1023 a to g transition at the splice acceptor site of exon 7 was identified in all three members of the family in the direct sequence analysis of MEN I gene. CONCLUSION: Genetic analysis for mutations in the MEN I family allows identification of individuals predisposed to the disease and enables an early diagnosis and more complete management. Also, this new diagnostic approach is helpful not only in genetic counselling of clinical management of the MEN I families but also in reducing health care expenses and psychological burden of the diseases.
Clinical Coding ; Delivery of Health Care ; Early Diagnosis ; Exons ; Genetic Testing ; Germ-Line Mutation ; Humans ; Male ; Multiple Endocrine Neoplasia Type 1* ; Pancreas ; Polymerase Chain Reaction ; RNA Splice Sites ; Sequence Analysis ; Sequence Analysis, DNA

A human cell-based liver model capable of long-term expansion and mature hepatic function is a fundamental requirement for pre-clinical drug development. We previously established self-renewing and functionally mature human pluripotent stem cell-derived liver organoids as an alternate to primary human hepatocytes. In this study, we tested long-term prolonged culture of organoids to increase their maturity. Organoid growing at the edge of Matrigel started to deteriorate two weeks after culturing, and the expression levels of the functional mature hepatocyte marker ALB were decreased at four weeks of culture. Replating the organoids weekly at a 1：2 ratio in fresh Matrigel, resulted in healthier morphology with a thicker layer compared to organoids maintained on the same Matrigel and significantly increased ALB expression until three weeks, although, it decreased sharply at four weeks. The levels of the fetal hepatocyte marker AFP were considerably increased in long-term cultures of organoids. Therefore, we performed serial passaging of organoids, whereby they were mechanically split weekly at a 1：3∼1：5 ratio in fresh Matrigel. The organoids expanded so far over passage 55, or 1 year, without growth retardation and maintained a normal karyotype after long-term cryopreservation. Differentiation potentials were maintained or increased after long-term passaging, while AFP expression considerably decreased after passaging. Therefore, these data demonstrate that organoids can be exponentially expanded by serial passaging, while maintaining long-term functional maturation potential. Thus, hepatic organoids can be a practical and renewable cell source for human cell-based and personalized 3D liver models.