189-192 Six male patients with typical symptoms of Behcet's syndrome were subjected to a clinical examination. One of these was a Chinese patient. The age when the disease started was between 20 to 39 years. All of them became blind but no one was dead.
Asian Continental Ancestry Group ; Behcet Syndrome* ; Humans ; Male

Aspergillus is usually found in the human upper respiratory tract, or soil, and causes sinusitis for the immunocompromised or immunocompetent hosts. Sometimes it extends to the cavernous sinus, internal carotid artery or the orbit and results in severe complications. We diagnosed cavernous sinus thrombosis and sphenoid sinusitis by Aspergillus in a 58-year-old woman who visited our clinic for headache, left eyeball pain, and proptosis. We treated the patient with endoscopic ethmoidectomy, sphenoidectomy and antifungal therapy with Amphotericin B. During one year of follow-up, we found no evidence of recurrence. Cavernous sinus thrombosis by Aspergillus is a rare disease, and can be treated successfully without recurrence with early diagonosis and vigorous treatment.
Amphotericin B ; Aspergillus* ; Carotid Artery, Internal ; Cavernous Sinus Thrombosis* ; Cavernous Sinus* ; Exophthalmos ; Female ; Follow-Up Studies ; Headache ; Humans ; Middle Aged ; Orbit ; Rare Diseases ; Recurrence ; Respiratory System ; Sinusitis ; Soil ; Sphenoid Sinus ; Sphenoid Sinusitis

The etiologic factors causing low back pain are numerous and variable. Orthopaedic sugreons tend to focus attention to any defects of structural and functional origins such as pine, discs and facet joints. Clinically, however, the fact remains that not all abnormal findings produce back pain and vice vera. Among the many modalities of investigation to determine the etiology of back pain, plain X-ray of the lumbosacral spine is the single most important acreening method. In addition to antero-posterior, lateral and oblique views, stress view of the spine gives certain clue to predict the disc degeneration. The X-ray findings of a total of 503 patients with low back pain (the study group). admitted during the year of 1977 to the Department of Orthopaedic Surgery, National Medical Center, were reviewed and compared with the control group of 100 patients without relevance to back pain (the control group). Our intention was to explore the relationship between the abnormal findings of plain X-rays and occurence of back pain. and to further entrance the diagnostic value of the spine. The study group of 503 patients (86 cases of which were operated on) were diagnosed not only by routine plain X-rays but also by contrast myelography and tomography in addition to detailed physical examination. Following observations were made: 1. The sex was nearly equally distributed in the atudy group of 503 patients. The age ranged from the second to the eighth decade, dominant group being the third to fifth decades. 2. The causes of the low back pain were herniated disc, spondylosis, spondylolysis, and infection, in that order. 119 patients (23.7%) out of the 503 showed no roentgenologicaI abnormal findings. 3. 384 cases out of the 503 revealed abnormal findings, mainly congenital or developmental and degenerative changes in that order. 4. In a comparative study with the control group, congenital or developmental anomalies and degenerative changes were not related to low back pain. Disc. space narrowing, supposed to be valuable in establishing the diagnosis of low back pain was present in 26% of the cases in study group and in 11% in the control group. 5. The age incidence of the low back pain with congenital or developmental anomalies was mainly in th second and third decades, while that of disc space narrowing was in the third to fifth decade. The degenerative changes of the spine appeared after the fourth decade. 6. Transitional vertebra and tropism are supposed to plsy a role on the degenerative change of the spine. 7. The stress study of the spine had some benifit it the diagnosis of disc degeneration. The mobility of the L4-5 lesion with low back pain was increased to mean 15.1 and standard deviation 3.7, in comparison to the mean 12.3 and standard deviation 3.7 in the control group.
Back Pain ; Diagnosis ; Humans ; Incidence ; Intention ; Intervertebral Disc Degeneration ; Intervertebral Disc Displacement ; Low Back Pain ; Methods ; Myelography ; Physical Examination ; Spine ; Spondylolysis ; Spondylosis ; Tropism ; Zygapophyseal Joint

The authors analyzed 30 patients whose celiac artery or its branches were dissected during the procedure of transcatheter arterial embolization (TAE) for hepatocellular carcinoma (HCC) and were followed up angiographically. The incidence of arterial dissection was 1.25%. The dissection occurred most frequently in the celiac artery (40% 12/30) and the proper hepatic artery(28% 7/30). The frequency of arterial dissection was affected by the status of the vessel and the experience of the operator. The follow-up angiography revealed complete recanalization in 40% (12/30), irregularity and narrowing of the lumen in 23% (7/30), pseudoaneurysm formation in 23%(7/30), and complete obstruction in 13% (4/30) of the cases. The rate of recanalization in the celiac artery was lower than that of any other arteries in our series. Recamalization to a certain degree without therapeutic intervention was observed in 72% of the dissected arteries enabling and contributing to subsequent successful TAE within 2 months in 78% of the patients with the dissection.
Aneurysm, False ; Angiography ; Arteries ; Carcinoma, Hepatocellular ; Celiac Artery* ; Follow-Up Studies* ; Humans ; Incidence

Though the malignancy of a tumor is generally postulated to be affected by the degree of differentiation of tumor cells, the relationship between differentiation and malignancy of tumors has not been clearly elucidated. Using in vitro established mouse(B16) and human(IGR3) melanoma cell lines, we performed various in vitro and in vivo experiments to clarify the relationship between melanogenicity and malignancy. High and low melanin-producing clones were selected from both cell lines by the limiting dilution technique and their melanogenicities were confirmed by the determination of melanin quantity and tyrosinase activity along with electron microscopic examination. Selected clones from both cell lines revealed that low melanin-producing clones showed a slightly broader chromosomal distribution, a shorter doubling time with a higher DNA synthesis and a greater colony forming capacity in semi-solid agar medium than those of high melanin-producing clones. The low melanin-producing clone derived from B16 also had a lower tumor-take dose and a more rapid tumor-growth rate than the high melanin-producing counterpart following transplantation into syngeneic mice. These results support the concept that the melanogenicity and other biological characteristics associated with malignancy are inversely related in malignant melanoma cells.
Animal ; Cell Line ; Human ; Melanins/*metabolism ; Melanoma/*pathology ; Melanoma, Experimental/*pathology ; Mice ; Mice, Inbred Strains ; Microscopy, Electron ; Neoplasm Transplantation ; Skin Neoplasms/*pathology ; Tumor Cells, Cultured/*pathology ; Tumor Stem Cell Assay

There is the trend of increasing number of outpatients who are requiring surgical intervention because of medical insurance and general improvement of economic state. Ambulatory surgical clinics are prospering in the United States. Thus we have analyzed 1957 cases of outpatient anesthesia excluding local infiltration performed by surgeons from total of 4302 cases o fout patient surgery during the 5 year period between 1975 and 1979. The results of this analysis were as follows: 1) Ketamine IM or IV was used as a sole agent in 500 cases who were under 12 years of age and mean operation and recovery time were 19.95 and 58. 45 minutes, respectively. 2) Mean operation and recovery time for 1,125 cases of pentothal+N2O+O2, anesthesia were 15. 55 and 108. 23 minutes, respectively. 3) For 321 cases of halothane+N2O+O2, anesthesia, mean operation and recovery time were 40.67 and 145. 94 minutes, respectively. 4) During recovery period there were no serious complications or mortality. 5) The majority of 1,125 among 1,957cases were gynecological outpatients and the rest were distributed among the surgical departments and dermatology, 6) Pentothal, nitrous oxide, halothane and ketamine were used safely for the outpatient anesthesia according to our experiences.
Anesthesia* ; Clinical Study* ; Dermatology ; Halothane ; Humans ; Insurance ; Ketamine ; Mortality ; Nitrous Oxide ; Outpatients ; Surgeons ; Thiopental ; United States

OBJECTIVE: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder with a bimodal pattern in age onset and treatment outcomes. This study attempted to ascertain the importance of the age factor for a better phenotypic precision. Therefore, the authors compared adult OCD patients with an early symptom onset to adult OCD patients with a later symptom onset. METHODS: One hundred sixty five patients with OCD were evaluated with semistructured interviews;79 with symptom onset before the age of 17 (early onset group) and 86 with symptom onset after the age of 17 (late onset group). The two groups were analyzed in terms of Y-BOCS (Yale-Brown Obsessive Compulsive Scale) scores and demographic data including clinical variables. RESULTS: Early onset group has more comorbidity of tic disorder and lesser of depression and anxiety disorder than late onset group. Early onset group showed more family history of tic disorder than late onset group. The treatment response to SSRI is relatively declined after 18 months of initiation in early onset group. CONCLUSION: The results indicate that age at onset may be an important factor in subtyping OCD. Early onset group may have more biological and familial tendency that might be differentiate the two groups.
Adult ; Age Factors ; Age of Onset ; Anxiety Disorders ; Comorbidity ; Depression ; Humans ; Obsessive-Compulsive Disorder* ; Tic Disorders

Purpose: Three years of adjuvant imatinib is the standard treatment for resected gastrointestinal stromal tumors (GISTs) with rupture, but the recurrence rate is prominently high. We aimed to investigate the efficacy and safety of 5-year adjuvant imatinib compared with 3-year treatment in patients with a ruptured GIST following surgical resection. Materials and Methods: A total of 51 patients were included in the analysis. The assessment of GIST rupture was based on Nishida’s classification. Twenty patients who were diagnosed before November 2013 were treated with 5 years of imatinib, and 31 patients who were diagnosed after November 2013 were treated with 3 years of imatinib. We retrospectively compared the clinical outcomes of the two groups. Results: Baseline characteristics and the incidence of the adverse events were generally comparable between the two groups. During a median follow-up duration of 43.8 months and 104.2 months in the 3- and 5-year group, 8 and 9 patients had a disease recurrence, respectively. The 5-year group showed better recurrence-free survival (RFS) than the 3-year group. In multivariate analysis, low mitotic index was a significant independent favorable prognostic factor for RFS, while 5-year imatinib treatment was marginally associated with a favorable RFS. Conclusion Five years of adjuvant imatinib treatment in patients with ruptured GIST was associated with favorable survival outcomes with manageable toxicity profiles. Our findings warrant validation and confirmation in future studies.

Purpose: Heterogeneous human epidermal growth factor receptor 2 (HER2) overexpression in gastric cancer may lead to a misdiagnosis of HER2 status. Accurate assessment of HER2 status is essential for optimal treatment as novel HER2-directed agents are being investigated in various clinical settings. We evaluated the usefulness of HER2 re-assessment following progression on first-line treatment in initially HER2-negative advanced gastric cancer (AGC) patients. Materials and Methods: We enrolled 177 patients with baseline HER2-negative AGC and performed HER2 re-assessment after progression on first-line treatment from February 2012 to June 2016 at Asan Medical Center, Seoul, Korea. The re-assessed HER2 status was analyzed with baseline HER2 status and clinical characteristics. Results: The median age was 54 years (range, 24 to 80 years), and 123 patients (69.5%) were men. Seven patients (4.0%) were HER2-positive on the re-assessment. Patients with baseline HER2 negativity confirmed by a single test (n=100) had a higher HER2-positive re-assessment rate compared to those who had repeated baseline testing (n=77) (5.0% vs. 2.6%). Among the patients with single baseline HER2 testing, the rate was higher in patients with baseline HER2 immunohistochemistry (IHC) 1+ compared to those with IHC 0 (13.4% vs. 3.6%). Conclusion Overall, 4.0% of patients with baseline HER2-negative AGC were HER2-positive on re-assessment, and the HER2-positive re-assessment rate was higher among patients who had a single test at baseline. HER2 re assessment may be considered for initially HER2-negative patients to determine their eligibility for HER2-directed therapy, particularly if their HER2 negativity was determined by a single test, especially if they had a single baseline HER2 IHC 1+ test.

OBJECTIVES: The objective of this study is to investigate a possible role for fetal cardiac axis in prenatal screening of congenital cardiac or extracardiac intrathoracic anomaly. Introduction: The incidence of the congenital heart disease is reported to be 8 per 1000 live births. The congenital heart disease is the most common major anomaly in newborn, and significantly affects perinatal morbidity and mortality. Because about 90% of congenital heart disease occurs in fetus without risk factors, it is important to screen congenital heart disease in low risk patients for the congenital heart disease. METHOD: 48 cases of cardiac(38 cases) and extracardiac intrathoracic(10 cases) anomaly and 205 cases for control were evaluated for measurement of cardiac axis and analyzed by Student`s t-test and correlation analysis with SPSS/PC+ packages. RESULTS: The mean cardiac axis of control group was 39.4degrees (SD: 9.2degrees, range: 20degrees ~ 65degrees), and in the lesion group it was 42.1degrees (SD: 28.9degrees, range: -34degrees ~ 127degrees). If we use mean cardiac axis+/-2SD of normal fetuses as a range of normal cardiac axis(21degrees ~ 58degrees), 16/48(33.3%) of the congeital heart disease or extracardiac intrathoracic anomaly will be detected and specificity, positive predictive value, negative predictive value of the fetal cardiac axis in screening cardiac or intrathoracic anomaly will be 96.6%, 69.6%, 86.1%, respectively. CONCLUSION: The fetal cardiac axis may be a useful parameter in screening fetal cardiac or extracardiac intrathoracic anomaly, and could be used clinically as a parameter for evaluation of the four-chamber view of the heart.
Axis, Cervical Vertebra* ; Fetus ; Heart ; Heart Defects, Congenital ; Heart Diseases ; Humans ; Incidence ; Infant, Newborn ; Live Birth ; Mass Screening* ; Mortality ; Prenatal Diagnosis ; Risk Factors ; Sensitivity and Specificity