OBJECTIVE:The purpose of this study is to evaluate the CT findings of the carcinoma of the ampulla of Vater and to differentiate from other periampullary carcinoma including the carcinoma of the distal common bile duct and pancreas head. MATERIALS AND METHODS: We retrospectively reviewed the CT findings of 13 cases of the carcinoma of the ampulla of Vater, 20 cases of the carcinoma of the distal common bile duct and 20 cases of the carcinoma of the pancreas head confirmed by pathology. Five millimeter consecutive settings of CT scan were performed in all cases on ampulla level with supine position. The CT findings were retrospectively evaluated in view of common bile duct dilatation, pattern of termination of bile duct, pancreatic duct dilatation, protruding mass in duodenal lumen, and regional lymph node metastasis. RESULTS: All case of the carcinoma of the ampulla of Vater(13/13) and distal common bile duct(20/20) showed common bile duct dilatation with abrupt termination. Among the 10 cases of the carcinoma of the pancreas head with common bile duct dilatation, five cases each had is abrupt termination(5/20) and gradual stenosis of bile duct(5/20). Five cases of the carcinoma of the ampulla of Vater(5/13) and four cases of the carcinoma of distal common bile duct(4/20) showed pancreatic duct dilatation and all cases of the carcinoma of pancreas head show pancreatic duct dialtation(20/20). Twenty cases of the carcinoma of the ampulla of Vater showed protruding mass in the medial wall of the second portion of the duodenum(12/13) but only one case of the carcinoma of the distal common bile duct(I/20) and five cases of the carcinoma of the pancreas head (5/20) had protruding mass in the duodenal lumen. Only one case of the carcinoma of the ampulla of Vater showed(1/13) regional lymph node metastasis but three cases of the carcinoma of the distal common bile duct(3/20) and 18 cases of the carcinoma of the pancreas head(18/20) showed regional lymph node metastasis. CONCLUSION: Common bile duct dilatation with abrupt termination, protruding mass in the duodenal lumen and rare lymph node metastasis in CT may suggest the carcinoma of the ampulla of Vater.
Ampulla of Vater* ; Bile ; Bile Ducts ; Common Bile Duct ; Constriction, Pathologic ; Dilatation ; Head ; Lymph Nodes ; Neoplasm Metastasis ; Pancreas ; Pancreatic Ducts ; Pathology ; Retrospective Studies ; Supine Position ; Tomography, X-Ray Computed

Isolated deficiency of 3-methylcrotonyl CoA carboxylase is a rare disorder of the catabolic pathway for leucine and many patients have mild symptoms or no symptom. However, the introduction of tandem mass spectrometry in newborn screening has revealed an unexpectedly high incidence of this disorder. We report an asymptomatic premature infant with isolated 3-methylcrotonyl CoA carboxylase deficiency detected by newborn screening program using tandem mass spectrometry. She was born at preterm, 36 weeks of gestation and her birth weight was 1,912 gm. She was delivered by Cesarian section due to maternal preeclampsia and oligohydramnios. An elevation of 3-hydroxyisovalerylcarnitine in a blood sample obtained at Seven days was detected by tandem mass screening. Massively elevated excretion of 3-hydroxyisovalerate and 3-methylcrotonylglycine was detected in the urine collected at 15 days. L-carnitine(100 mg/kg/day) was administrated orally to correct sencondary carnitine deficiency. Carnitine is conjugated with metabolites, to decrease the potential toxic effects. She is asymptomatic to date, and her growth and development are within normal limits.
Birth Weight ; Carnitine ; Female ; Growth and Development ; Humans ; Incidence ; Infant, Newborn* ; Infant, Premature ; Leucine ; Mass Screening* ; Oligohydramnios ; Pre-Eclampsia ; Pregnancy ; Tandem Mass Spectrometry*

Telepathology systems will be common systems in hospitals. The two systems were designed and implemented in web environments for test. One was implemented with the Common Object Request Broker Architecture (CORBA) technique. The other system was implemented in the form of ActiveX. The histopathological materials were stained by Hematoxylin and Eosin. By the Donpisha CCD camera attached to an Olympus BX-51 optical microscope 180 color images come to be acquired. For evaluation of the systems, transmission times and telediagnosis concordance rates were measured. Image processing ability was tested using two telepathology systems. For the local area test, system I using CORBA had measured image transmission times of 0.1 s, 0.2 s, and 0.4 s at the file sizes of 100 K byte, 900 K byte and 3.6 M byte respectively. Transmission times for system II using Component Object Model (COM) were slightly slower, ranging from 0.02 s to 0.05 s. In the long distance area test, system II transmission times were 0.5 s, 0.8 s, and 2.0 s. The overall concordance rate of telediagnosis for the 180 images was 78.3%. In this study, we compared our systems about image transmission, and processing for the further development of system configurations.
Eosine Yellowish-(YS) ; Hematoxylin ; Internet* ; Telepathology*

Bartter's syndrome is characterized by hyperreninemia, hyperaldosteronism, hypokalemic hypochlorenlic alkalosis, normal blood pressure, juxtaglomerular apparatus hyperplasia, general weakness, and muscle weakness. We experienced a case of hypokalemic myopathy associated with Bartter's syndrome in 15 years old male. He had experienced paroxysmal muscle weakness without sensory change and myalgia since 10 years old. Subsequently, he had complaints of progressive muscle weakness, especially proximal muscles. Prominent juxtaglomerular apparatus with cellular proliferation biopsy was seen in the kidney. And there were mild perivascular inflammatory cell infiltration, small degenerating and/or regenerating muscles fibers, and normal muscle fiber distribution without evidence of chronic myopathy in the muscle biopsy. The patient was sucessfully managed with indomethacin and oral potassium chloride.
Adolescent ; Alkalosis ; Bartter Syndrome* ; Biopsy ; Blood Pressure ; Cell Proliferation ; Child ; Humans ; Hyperaldosteronism ; Hyperplasia ; Indomethacin ; Juxtaglomerular Apparatus ; Kidney ; Male ; Muscle Weakness ; Muscles ; Muscular Diseases* ; Myalgia ; Potassium Chloride

Hereditory Sensory Autonomic Neuropathy(HSAN) is variable rare disorder. So the classification of HSAN could be somewhat unsettled. There are intermingled overlap variants of HSAN in view of clinical manifestations and pathologic findings. Five types of HSAN have been described by Dyck(1993). Type I is dominantly inherited and affects both myelinated(MFs) and unmyetinated fibers(Ufs). Type II is recessively inherited and nerve biopsies show total absence of MFs but presence of Ufs. Type III is a recessive inherited dysautonomia. Type IV is characterized by insensitive to pain anhidrosis, and mild mental retardation with virtually absence of Ufs. Type V affects small MFs. We report a 5 year-old girl who presented with congenital insensitivity to pain, anhidrosis with mild mental retardation. In sural nerve biopsy, Ufs were virtually absent by electron microscopy. We reconfirmed previous pathologic findings in sural nerve of HSAN IV.
Biopsy ; Child, Preschool ; Classification ; Female ; Hereditary Sensory and Autonomic Neuropathies ; Humans ; Hypohidrosis* ; Intellectual Disability ; Microscopy, Electron ; Pain Insensitivity, Congenital* ; Primary Dysautonomias ; Sural Nerve

BACKGROUND: Cervical tuberculous lymphadenitis(CTL) is one of the most common extra-pulmonary tuberculosis. Recently overall incidence of pulmonary tuberculosis has decreased, but the incidence of tuberculous lymphadenitis has not decreased. Its duration of treatment is still controversial and the pathogenesis, prognosis and relationship with other site tuberculous are poorly published. So we did a retrograde study of 120 cases of confirmed CTL about its clinical manifestations. METHODS: All patients were applied fine needle aspiration(FNA) of palpable enlarged cervical lymph nodes and 114 patients were examined for AFB smear and 34 patients for TB culture with aspirated fluid. 57 patients were examined Mantoux test(5TU with PPD-S). With above methods, a total of 120 patients was diagnosed as having CTL RESULTS: 1) CTL is most prevalent in young women between the age of 20 30 years and the incidence of CTL in female is 2.5 times higher than that of male. It is located most commonly in the posterior cervical area. The most common presenting symptom is painless palpable enlarged cervical lymph nodes. 2) With FNA of enlarged cervical lymph nodes, the percentage of histopathological positivity is 82.3%. The percentage of AFB smear positivity is 38.6%, and that of TB culture positivity is 17.6% (p<0.001). 3) Pulmonary tuberculosis is noted in 79 cases(65.8%). And 42 cases(53.5%) of them had minimal pulmonary tuberculosis. In 14 cases(11.7%),other extrapulmonary tuberculosis coexsisted and pleural tuberculosis was most common in the order. 4) CTL was treated with anti-tuberculous medication(first line drug) and median treatment duration was 18.5months. During treatment, the size of involved lymph nodes decreased gradually in 62 cases(75.8%), newly developed lymph nodes were found in 25 cases(30.4%),fluctuation formation in 22 cases(26.8%) and fistula formation in 14 cases(17.0%). CONCLUISON: CTL is prevalent in women between the age of 20 ~ 40 years and it involves posterior cervical area most commonly. CTL is treated with long-term anti-tuberculous chemotherapy. We think it is one manifestation of systemic disease and frequently coexisting with pulmonary tuberculosis. Despite anti-tuberculous chemotherapy, the size of involved lymph nodes was increased, new lymph nodes were developed or fluctuation and fistula formed in involved lymph nodes. After sufficient medication, when the patient felt pressure discomfort from enlarged lymph node or fistula was formed, we recommended total excision of involved lymph nodes.
Drug Therapy ; Female ; Fistula ; Humans ; Incidence ; Lymph Nodes ; Male ; Needles ; Prognosis ; Tuberculosis ; Tuberculosis, Lymph Node* ; Tuberculosis, Pleural ; Tuberculosis, Pulmonary

BACKGROUND: Lung cancer continues to increase worldwide. Also, the proportion of female patients incease and adenocarcinoma is the predominant histological type among lung cancer in many western countries. So, we studied these current trends of lung cancer by clinical approach of recent patients from our department. METHOD: We conducted a retrospective analysis on 212 subjects who were diagnosed with lung cancer at the department of chest medicine in National Medical Center between January 1990 and July 1996. The contents of analysis were patient's profile, clinical manifestation, smoking habits, accuracy of diagnostic methods, histological cell type, staging and treatment, etc. RESULTS: The results were as follows. 1) The ratio of male to female was 5.2:1. The peak incidence of age was 7th decade(35.4 %). 2) Chief complaints were cough, dyspnea and chest pain, etc. The most common duration of symptoms before the first admission was less than 3 months(57.7%). On the other side, duration more than 1 year represented 6.5%. The early diagnosed patients has been increased from the 1980s. 3) Smokers among the total patients were 77.2%. The proportion of smokers in sqamous cell carcinoma, small cell carcinoma and adenocarcinoma were 88.4%, 85.7% and 55.7%, respectively. Smoking history and histological cell type were correlated in squamous and small cell carcinoma. 4) Squamous cell carcinoma is still the predominant histological type(44.8%), but, adenocarcinoma increased more than the previous study(30.7%). The other histological types were small cell carcinoma(17.0%) and large cell carcinoma(3.8%) in order of their proportions. 5) The accuracy of diagnostic methods were as follows : sputum cytology 75.3%, bronchoscopic biopsy 65.7%, lymph node aspiration cytology 95.8%, percutaneous lung aspiration cytology 94.6% and open lung biopsy 100%. The general accuracies of diagnostic methods were improved than previous studies. 6) Performance status scales on admission were relatively good. After diagnosis, chemotherapy and/or radiotherapy were undertaken in 69.3% of the patients, and only 7.5% of the patients were operated. CONCLUSION: In our study, squamous cell carcinoma is still the predominant histological cell type, but, adenocarcinoma continues to increase. Because adenocarcinoma is less correlated with smoking habits, further evaluation of other carcinogens than smoking is requested. Screening and early diagnosis of lung cancer is important for good performance status scales in spite of advanced stages. But, we think that the prevention, for example, stop smokings is more important as because of no perfect treatment for lung cancer.
Adenocarcinoma ; Biopsy ; Carcinogens ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Chest Pain ; Cough ; Diagnosis ; Drug Therapy ; Dyspnea ; Early Diagnosis ; Female ; Humans ; Incidence ; Lung ; Lung Neoplasms ; Lymph Nodes ; Male ; Mass Screening ; Radiotherapy ; Retrospective Studies ; Smoke ; Smoking ; Sputum ; Thorax ; Weights and Measures

Excessive concentration of stress which is occurred in occlusion around the implant in case of the implant supported fixed partial denture has been known to be the main cause of the crestal bone destruction. Therefore, it is essential to evaluate the stress analysis on supporting tissue to get higher success rates of implant. The purpose of this study was to evaluate the effects of stress distribution and deformation in 3 different types of three-unit fixed partial denture supported by two implants, using a three dimensional finite element analysis in a three dimensional model of a whole mandible. A mechanical model of an edentulous mandible was generated from 3D scan, assuming two implants were placed in the left premolars area. According to the position of pontic, the experiments groups were divided into three types. Type I had a pontic in the middle position between two implants, type II in the anterior position, and type III in the posterior position. A 100-N axial load was applied to sites such as the central fossa of anterior and posterior implant abutment, central fossa of pontic, the connector of pontic or the connector between two implants, the mandibular boundary conditions were modeled considering the real geometry of its four-masticatory muscular supporting system. The results obtained from this study were as follows; 1. The mandible deformed in a way that the condyles converged medially in all types under muscular actions. In comparison with types, the deformations in the type II and type III were greater by 2-2.5 times than in the type I regardless of the loading location. 2. The values of von Mises stresses in cortical and cancellous bone were relatively stable in all types, but slightly increased as the loading position was changed more posteriorly. 3. In comparison with type I, the values of von Mises stress in the implant increased by 73% in Type II and by 77% in Type III when the load was applied anterior and posterior respectively, but when the load was applied to the middle, the values were similar in all types. 4. When the load was applied to the centric fossa of pontic, the values of von Mises stress were nearly 30~35% higher in the type III than type I or II in the cortical and cancellous bone. Also, in the implant, the values of von Mises stress of the type II or III were 160~170% higher than in the type I. 5. When the load was applied to the centric fossa of implant abutment, the values of von Mises stress in the cortical and cancellous bone were relatively 20~25% higher in the type III than in the other types, but in the implant they were 40-45% higher in the type I or II than in the type III. According to the results of this study, musculature modeling is important to the finite element analysis for stress distribution and deformation as the muscular action causes stress concentration. And the type I model is the most stable from a view of biomechanics. Type II is also a clinically acceptable design when the implant is stiff sufficiently and mandibular deformation is considered. Considering the high values of von Mises stress in the cortical bone, type III is not thought as an useful design.
Bicuspid ; Biomechanics ; Denture, Partial, Fixed ; Finite Element Analysis ; Mandible

Excessive concentration of stress which is occurred in occlusion around the implant in case of the implant supported fixed partial denture has been known to be the main cause of the crestal bone destruction. Therefore, it is essential to evaluate the stress analysis on supporting tissue to get higher success rates of implant. The purpose of this study was to evaluate the effects of stress distribution and deformation in 3 different types of three-unit fixed partial denture supported by two implants, using a three dimensional finite element analysis in a three dimensional model of a whole mandible. A mechanical model of an edentulous mandible was generated from 3D scan, assuming two implants were placed in the left premolars area. According to the position of pontic, the experiments groups were divided into three types. Type I had a pontic in the middle position between two implants, type II in the anterior position, and type III in the posterior position. A 100-N axial load was applied to sites such as the central fossa of anterior and posterior implant abutment, central fossa of pontic, the connector of pontic or the connector between two implants, the mandibular boundary conditions were modeled considering the real geometry of its four-masticatory muscular supporting system. The results obtained from this study were as follows; 1. The mandible deformed in a way that the condyles converged medially in all types under muscular actions. In comparison with types, the deformations in the type II and type III were greater by 2-2.5 times than in the type I regardless of the loading location. 2. The values of von Mises stresses in cortical and cancellous bone were relatively stable in all types, but slightly increased as the loading position was changed more posteriorly. 3. In comparison with type I, the values of von Mises stress in the implant increased by 73% in Type II and by 77% in Type III when the load was applied anterior and posterior respectively, but when the load was applied to the middle, the values were similar in all types. 4. When the load was applied to the centric fossa of pontic, the values of von Mises stress were nearly 30~35% higher in the type III than type I or II in the cortical and cancellous bone. Also, in the implant, the values of von Mises stress of the type II or III were 160~170% higher than in the type I. 5. When the load was applied to the centric fossa of implant abutment, the values of von Mises stress in the cortical and cancellous bone were relatively 20~25% higher in the type III than in the other types, but in the implant they were 40-45% higher in the type I or II than in the type III. According to the results of this study, musculature modeling is important to the finite element analysis for stress distribution and deformation as the muscular action causes stress concentration. And the type I model is the most stable from a view of biomechanics. Type II is also a clinically acceptable design when the implant is stiff sufficiently and mandibular deformation is considered. Considering the high values of von Mises stress in the cortical bone, type III is not thought as an useful design.
Bicuspid ; Biomechanics ; Denture, Partial, Fixed ; Finite Element Analysis ; Mandible

Hydroxyapatite is commonly used as a filler to replace amputated bone or as a coating to promote bone ingrowth into prosthetic implants. Many modern implants, such as hip replacements and dental implants, are coated with hydroxyapatite. We report a patient with occupational asthma due to hydroxyapatite, proven by a specific inhalation challenge, who experienced an early asthmatic reaction after exposure to hydroxyapatite, without increased airway responsiveness to methacholine despite an increased eosinophil count in the peripheral blood. A 38-year-old male dental implant worker visited our allergy department for the evaluation of occupational asthma. He had treated dental implant titanium surfaces with hydroxyapatite for 1.5 years. One year after starting his employment, he noticed symptoms of rhinorrhea, paroxysmal cough, and chest tightness. His symptoms were aggravated during and shortly after work and subsided several hours after work. When he stopped working for 2 months because of his chest symptoms, he became asymptomatic. After restarting his work, his symptoms reappeared and were aggravated. A methacholine bronchial challenge test had a negative response. The following day, a specific bronchial provocation test with wheat powder was negative. On the third day, a specific bronchial provocation test with hydroxyapatite powder produced an early asthmatic response. On the fourth day, a methacholine bronchial challenge test was negative. Further studies are needed to evaluate the exact pathogenetic mechanism of hydroxyapatite-induced occupational asthma.
Adult ; Asthma ; Asthma, Occupational ; Bronchial Provocation Tests ; Cough ; Dental Implants ; Durapatite ; Employment ; Eosinophils ; Hip ; Humans ; Hypersensitivity ; Inhalation ; Male ; Methacholine Chloride ; Occupations ; Thorax ; Titanium ; Triticum