No abstract available.
Abdomen ; Syringoma

No abstract available.
Abdomen ; Syringoma

PURPOSE: To evaluate the risk of vertebral compression fracture (VCF) after conventional radiotherapy (RT) for colorectal cancer (CRC) with spine metastasis and to identify risk factors for VCF in metastatic and non-metastatic irradiated spines. MATERIALS AND METHODS: We retrospectively reviewed 68 spinal segments in 16 patients who received conventional RT between 2009 and 2012. Fracture was defined as a newly developed VCF or progression of an existing fracture. The target volume included all metastatic spinal segments and one additional non-metastatic vertebra adjacent to the tumor-involved spines. RESULTS: The median follow-up was 7.8 months. Among all 68 spinal segments, there were six fracture events (8.8%) including three new VCFs and three fracture progressions. Observed VCF rates in vertebral segments with prior irradiation or pre-existing compression fracture were 30.0% and 75.0% respectively, compared with 5.2% and 4.7% for segments without prior irradiation or pre-existing compression fracture, respectively (both p < 0.05). The 1-year fracture-free probability was 87.8% (95% CI, 78.2-97.4). On multivariate analysis, prior irradiation (HR, 7.30; 95% CI, 1.31-40.86) and pre-existing compression fracture (HR, 18.45; 95% CI, 3.42-99.52) were independent risk factors for VCF. CONCLUSION: The incidence of VCF following conventional RT to the spine is not particularly high, regardless of metastatic tumor involvement. Spines that received irradiation and/or have pre-existing compression fracture before RT have an increased risk of VCF and require close observation.
Colorectal Neoplasms* ; Follow-Up Studies ; Fractures, Compression* ; Humans ; Incidence ; Multivariate Analysis ; Neoplasm Metastasis ; Radiotherapy ; Retrospective Studies ; Risk Factors ; Spinal Fractures ; Spinal Neoplasms ; Spine*

Ethical problems in an emergency department (ED) are much more common than is usually recognized. But these difficult ethical dilemmas have not been dealt with by general medical ethicists. Most medical ethics guidelines tend to concentrate on chronic or at least relatively stable situations rather than on the acute, episodic cases that are typical in the ED. most ethical problems such as abortion, euthanasia, and professionalism can be solved after reflection and deliberation, and after a process of communication that reveals the values and interests of the patient or the patient's family. In contrast, when health care professionals in the ED recognize ethical problems, they often don't have enough time for an ethical consultation such as a Hospital Ethics Committee. Ethical principles such as autonomy, beneficence, nonmaleficence, and justice need to be applied to the unique setting of emergency medicine. Hence, it is necessary to develop ethics guidelines in emergency medicine and ethics education for health care professionals in emergency departments. At first, we collected cases involving ethical problems and reviewed the ethical and legal aspects of those cases. In this article, we summarize the ethical issues in emergency medicine, deal with actions in emergency medical services, and also consider the relationships between ethical issues and act on emergency medical services. We want to present the important factors that should be considered in ethical decision making within an emergency medicine department including patient decision making capacity, legal custody, and ethical principles.
Beneficence ; Decision Making ; Delivery of Health Care ; Emergencies ; Emergency Medical Services ; Emergency Medicine ; Ethicists ; Ethics Committees, Clinical ; Ethics, Medical ; Euthanasia ; Humans ; Jurisprudence ; Social Justice

Pulmonary tuberculosis is still endemic in Korea, but esophageal tuberculosis, especially primary esophageal tuberculosis, is very rarely seen. A 76-year-old male is presented dysphagia. The clinical presentation, barium swallow study, and chest CT were suggestive of carcinoma of the esophagus. Findings that can suggest the diagnosis are enlarged lymph nodes, ulceration, and luminal narrowing. The major differential diagnosis was primary esophageal tuberculosis. This was not excluded on biopsy obtained at endoscopy. Operation was done for severe dysphagia and exclusion of malignancy. The patient was finally diagnosed as primary esophageal tuberculosis.
Aged ; Barium ; Biopsy ; Deglutition Disorders ; Diagnosis ; Diagnosis, Differential ; Endoscopy ; Esophagus ; Humans ; Korea ; Lymph Nodes ; Male ; Phenobarbital ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Pulmonary ; Ulcer

PURPOSE: While acute urinary retention(AUR) secondary to bladder outlet obstruction in the male occurs commonly and rarely causes difficulty with diagnosis and treatment but AUR in female is an uncommon findings. This study was performed to evaluate AUR in possible causes by urodynamic study and analyzed the results of treatment. MATERIAL AND METHODS: We have retrospectively tried to evaluate the possible causes of AUR in 41 female patients. Urine analysis, urine culture, urodynamic study and selectively cystoscopy were performed in 41patients. We analysed the urodynamic feature respectively and classified into areflexia type, hyperreflexia type, detrusor hyperreflexia with impaired contractility(DHIC) type and normal finding. RESULTS: The mean age of patients was 57.9 years. Major causes of AUR were CNS lesion(13 cases, 31.7%), diabetes mellitus(6 cases, 15.3%) and spinal lesion(4 cases, 10.2%). Urethral catheterization was employed as initial treatment in 32 cases(78.0%). Catheter was removed after mean 5.2 days and selective urodynamic study was done in 36 cases. Urodynamically, there were hyperreflexia type 16 cases(44.4%), areflexic type 9 cases(25%), DHIC type 6 case(16.7%), normal finding 5 cases(13.9%). The treatments of areflexic type included intermittent catheterization(IC) in 4 cases (44.4%), urethral catheterization in 3 cases (33.3%), medical therapy in 2 cases(22.2%). The treatments of hyperreflexia type included IC in 4 cases(25%), urethral catheterization in 1 case(6.3%) and medical therapy in 11 cases(68.8%). The treatments of DHIC type included IC in 2 cases(5.5%), urethral catheterization in 1 case(2.8%), medical therapy in 2 cases(5.5%) and ileal conduit in 1 case(2.8%). CONCLUSIONS: Causes of female AUR were commonly considered the functional urinary retention and rarely organic urinary retention, but there were various causes. Our study indicated the need to consider the gender and urodynamic finding on the evaluation and treatment of AUR.
Catheters ; Cystoscopy ; Diagnosis ; Female ; Humans ; Male ; Reflex, Abnormal ; Retrospective Studies ; Urinary Bladder Neck Obstruction ; Urinary Catheterization ; Urinary Catheters ; Urinary Diversion ; Urinary Retention* ; Urodynamics

Anti-Müllerian hormone (AMH) is now accepted as an important clinical marker of ovarian reserve and is increasingly measured as an initial evaluation at infertility clinics. The aim of this study was to establish reference values for the revised second generation (Gen II) assay using population-based data. In this population-based cohort study, AMH data from unselected infertile women aged 25–45 years from June 2013 to June 2014 (n = 15,801) were collected. The AMH values were measured using the revised Gen II assay. We established and validated 5 AMH-age regression models. Based on the optimal AMH-age model, reference values and centile charts were obtained. The quadratic model (log AMH = 0.410 × age − 0.008 × age²− 3.791) was the most appropriate for describing the age-dependent decrease in AMH measured using the revised Gen II assay. This is the largest population-based study to establish age-specific reference values of AMH using the revised Gen II assay. These reference values may provide more specific information regarding the ovarian reserve estimation of infertile women.
Biomarkers ; Cohort Studies ; Female ; Humans ; Infertility ; Ovarian Reserve ; Reference Values*

Simultaneous multi-vessel acute myocardial infarction is rare and has poor prognosis. We report a 70-year-old Korean man with an anteroseptal wall ST-elevation myocardial infarction presenting as ventricular tachycardia, sudden cardiac arrest and cardiogenic shock. After successful cardiopulmonary resuscitation, a coronary angiogram revealed three-vessel coronary disease; simultaneous total occlusions of the proximal left anterior descending artery (LAD) and the proximal left circumflex artery (LCX), and chronic total occlusion of the proximal right coronary artery. Primary percutaneous coronary intervention (PCI) of the LAD and LCX was successful and an intra-aortic balloon pump was inserted. Despite the timely and successful PCI result, he died on the 58th day in the hospital due to pneumonia with multiple organ failure.
Aged ; Arteries ; Cardiopulmonary Resuscitation ; Coronary Disease ; Coronary Occlusion ; Coronary Vessels ; Death, Sudden, Cardiac ; Humans ; Multiple Organ Failure ; Myocardial Infarction* ; Percutaneous Coronary Intervention ; Pneumonia ; Prognosis ; Shock, Cardiogenic ; Tachycardia, Ventricular

Primary leiomyosarcoma is an extremely rare tumor. We exprienced a case of 46-year-old man with a mass located in the left upper lobe bronchus which was discovered on a chest CT. Cytology of the sputum and bronchoscopic biopses did not reveal any malignant cells. The patient underwent a left sleeve upper lobectomy. The tumor was growing from the left upper lobe bronchus and had partially destroyed the lung parenchyme. The pathologic feature of the tumor was composed of fascicular arrayed cellular spindle cells with blunt-ended nuclei revealed mild to moderate pleomorphism and frequent mitoses (15/10HPF). The immunohistochemical staining was revealed positive reaction for antibody to smooth muscle actin and desmin. We conclude that the tumor is leiomyosarcoma of the lung and then report with a review of the literatures.
Actins ; Bronchi ; Desmin ; Humans ; Leiomyosarcoma* ; Lung* ; Middle Aged ; Mitosis ; Muscle, Smooth ; Sputum ; Subclavian Artery ; Thoracic Outlet Syndrome ; Tomography, X-Ray Computed

PURPOSE : To present our experiences in pseudomosaicism or maternal celi contamination in genetic mid-trimester amniocentesis confirmed through percuraneous umbilical blood sampling. METHODS : From 1992 to 1997, repeated cytogenetic evaluation with fetal cord blood was carried out in 14 cases showing mosaic patterns. RESULTS : We confirmed pseudomosaicsm in 12 cases (85.7%) by repeated cytohenetic evaluation, and also maternal cell contamination in 2 cases. CONCLUSIONS : Repeated cytohenetic evaluation via percutaneous umbilical blood sampling was a rapid and useful method fof the confirmation of mosaicism resulted from genetic mid-trimester amnicentesis.
Amniocentesis ; Cordocentesis ; Cytogenetics ; Fetal Blood ; Mosaicism