Cogan's syndrome is a rare chronic inflammatory disease Characterized by non-syphilitic keratitis and vestibuloauditory dysfunction. Although the precise pathogenesis of Cogan's syndrome is unknown, it is thought to develop from vasculitis involving multiple organ system. It can be accompanied with various systemic diseases including arthritis, lymphadenopathy, splenomegaly, and aortitis with insufficiency. We report a case of typical Cogan's syndrome with multiple cerebral infarctions.
Aortitis ; Arthritis ; Cerebral Infarction ; Cogan Syndrome ; Keratitis ; Lymphatic Diseases ; Splenomegaly ; Vasculitis

A 46-year-old male patient developed jaundice after 23 days' treatment of propylthiouracil (PTU) for Graves' disease. Serum alkaline phosphatase was elevated markedly with moderate increase in serum aminotransferase, and the peak level of total bilirubin was 7.3 mg/dL. After withdrawal of PTU, serum aminotransferase and bilirubin began to decrease simultaneously, and completely normalized. One week after the discharge from hospital, he received radioiodine treatment for Graves' disease, but he showed aggravation of hyperthyroidism and ophthalmopathy. So we prescribed methimazole inevitably 16 days' after the radiodiodine treatment. He developed jaundice again after 69 days' treatment of methimazole, but the pattern of hepatotoxicity was slightly different from that of the previous PTU-nduced hepatotoxicity. Serum aminotransferase increased slightly and quickly normalized after discontinuance of methimazole, but serum total bilirubin increased continuously and reached to 24.6 mg/dL. Eosinophilia was prominent and the result of liver biopsy was compatible with cholestatic jaundice. The patient was treated with prednisolone and recovered from jaundice rapidly.
Alkaline Phosphatase ; Bilirubin ; Biopsy ; Eosinophilia ; Graves Disease ; Humans ; Hyperthyroidism ; Jaundice ; Jaundice, Obstructive ; Liver ; Male ; Methimazole* ; Middle Aged ; Prednisolone ; Propylthiouracil*

BACKGROUND/AIMS: NAD glycohydrolase (NADase) is abundantly expressed in the liver. This expression is prominent in Kupffer cells. Since it was recognized that reticulendothelial function is impaired in liver cirrhosis, we assessed how these enzyme activities were altered in patients with liver cirrhosis. METHODS: Serum samples were obtained from 61 patients with liver cirrhosis (according to the criteria of Child-Pugh 15 were classified A, 24 were classified B, and 22 were classified C) and 16 healthy subjects. NADase activities were measured fluorometrically with [adenine-14C] NAD. The reaction mixture contained [adenine-14C] NAD and enzyme (patient serum). The reaction was stopped after a 30 to 480 min incubation by the addition of 50 L of 25% trichloroacetic acid. RESULTS: Serum NADase activities in 61 patients with liver cirrhosis were significantly lower than those in healthy subjects (33+/-14 vs. 55.6+/-13 p<0.001). Serum NADase activities in severe cirrhotic patients were significantly lower than those in mild to moderate cirrhotic patients (criteria of Child-Pugh, A: 40.6+/-6.4 vs. B: 38.6+/-13 vs. C: 21.8+/-14, p<0.001). NADase activities were correlated to prothrombin time (r = 0.69), and Apo A1 (r = 0.58) that were useful in identifying high-risk subjects for severe liver disease, but not asparate aminotransferase (AST) and alanine aminotransferase (ALT). Also, NADase activities reciprocally correlated with PGAA index (r = -0.78), Child-Pugh's score (r = -0.48), and serum alpha-2-macroglobulin (r = -0.72). CONCLUSIONS: NADase activities could be used as a single diagnostic marker for liver cirrhosis in addition to the Child-Pugh's score and PGAA index.
Alanine Transaminase ; Apolipoprotein A-I ; Humans ; Kupffer Cells ; Liver Cirrhosis* ; Liver Diseases ; Liver* ; NAD* ; NAD+ Nucleosidase* ; Prothrombin Time ; Trichloroacetic Acid

The first documented case of duodenal carcinoma was described by Hamburger in 1746. Primary adeno-carcinoma of duodenum is rare. Malignant tumors of the small bowel are reported to account for about 1% of all gastrointestinal carcinoma. The autopsy incidence of duodenal adenocarcinoma is about 0.3% of all malignancy. The second and third portions of the duodenum are the usual sites of adenocarcinoma. Cancer in the duodenal bulb is exceedingly rare. Most of them revealed an intraluminal mass or wall thickening. But we have experienced a case of exophytic growth pattern adenocarcinoma such as the fistula of duodenal bulb in 49 year old male patient with hematemesis. For its great rarity, we report this case with review of literatures.
Adenocarcinoma* ; Autopsy ; Duodenum ; Fistula* ; Hematemesis ; Humans ; Incidence ; Male ; Middle Aged

Background: Benign bladder tumors are rare disease entities, and insufficient studies have assessed their epidemiological characteristics. The authors investigated the prevalence of benign bladder tumors by retrospectively investigating pathology reports of transurethral resection of bladder tumor (TURBT) procedures over the past 20 years. Methods: We analyzed 1,674 pathology reports of TURBT conducted in 1,160 patients from January 1, 2000, to April 30, 2022. The prevalence of benign tumors and histological classification according to the presence of primary (group 1) and recurrent (group 2) bladder lesions were retrospectively investigated. Results: The mean age of patients was 65.2±11.5 years, and 1,284 cases (79.1%) were in men. Benign bladder tumors comprised 278 cases (248 patients) accounting for about 17.1% of the total TURBT cases (278/1,624). Furthermore, 184 patients (16.0%, 184/1,147) belonged to group 1 and 78 patients (27.4%, 78/285) belonged to group 2. Among all benign lesions that underwent TURBT, cystitis was the most common (41.0%, 114/278), and this rate was higher in group 2 (64/184 [34.8%] vs. 50/94 [53.2%], p<0.001). The prevalence of non-neoplastic lesions was higher in group 1 (44/184 [23.9] vs. 11/94 [11.7%], p<0.001). There was no difference in the prevalence of noninvasive urothelial neoplasms between the two groups (22/184 [12.0%] vs. 8/94 [8.5%], p=0.86). Conclusions The probability of benign lesions in TURBT was 17.1%, among which cystitis was the most common. When TURBT was performed for recurrent lesions, the frequency of benign tumors was higher than that of primary benign bladder tumors.

OBJECTIVES: The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). MATERIALS AND METHODS: The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). RESULTS: The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was 2.23±0.92 mm (P<0.01) forward movement and −0.87±0.57 mm (non-significant, NS) upward movement on the basis of point B and 2.54±1.37 mm (P<0.01) forward movement and −1.18±0.79 mm (NS) upward movement on the basis of the pogonion (Pog) point. The relapse amount of the mandible in the surgery-first orthognathic approach group from T1 to T2 was 3.49±1.71 mm (P<0.01) forward movement and −1.78±0.81 mm (P<0.01) upward movement on the basis of the point B and 4.11±1.93 mm (P<0.01) forward movement and −2.40±0.98 mm (P<0.01) upward movement on the basis of the Pog. CONCLUSION: The greater horizontal and vertical relapse may appear because of counter-clockwise rotation of the mandible in surgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.
Congenital Abnormalities ; Humans ; Mandible ; Orthognathic Surgery* ; Osteotomy, Sagittal Split Ramus* ; Prognathism ; Recurrence

BACKGROUND: Acute renal failure is one of the leading causes of postoperative morbidity and mortality. The purpose of this study was to determine the risk factors that are associated with acute renal failure after colorectal surgery. MATERIALS AND METHODS: Five hundred seventy patients who operated colorectal surgery at the Yeungnam University Medical Center over three years from 2004 to 2006 were enrolled in this study. The effects of gender, age, ASA classification, concomitant disease, surgery type and duration, reoperation, urogenital manipulation, medication, hypotension, hypovolemia, transfusion, and postoperative ventilatory care on the occurrence of acute renal failure after colorectal surgery were studied. RESULTS: The major risk factors of acute renal failure after colorectal surgery were age of patients (P=0.003), ASA classification (P<0.001), concomitant disease (P<0.001), duration of the time surgery (P=0.034), reoperation (P=0.001), use of intraoperative diuretics (P=0.005), use of postoperative diuretics (P<0.001), intraoperative hypotension (P=0.018), intraoperative transfusion (P<0.001), postoperative transfusion (P<0.001), and postoperative ventilatory care (P=0.001). CONCLUSION: Multiple factors cause synergistic effects on the development of acute renal failure after colorectal surgery. Therefore, efforts to reduce the risk factors associated with acute renal failure are needed. In addition, intensive postoperative care should be provided to all patients.
Academic Medical Centers ; Acute Kidney Injury* ; Classification ; Colorectal Surgery* ; Diuretics ; Humans ; Hypotension ; Hypovolemia ; Mortality ; Postoperative Care ; Reoperation ; Risk Factors*

No abstract available.
Hydrocephalus, Normal Pressure ; Myotonic Dystrophy

Moyamoya disease is a cerebrovascular disorder characterized by progressive stenosis of the distal internal carotid arteries, and in rare cases can occur in association with optic disc coloboma. We describe a 31-year-old man with transient left-sided weakness caused by steno-occlusion of the bilateral internal carotid arteries. A fundoscopic examination revealed a coloboma involving the optic disc of the right eye. Clinicians should be aware of the possibility of moyamoya disease in patients with optic disc coloboma, even when other classic symptoms of this disease are absent.
Adult ; Carotid Artery, Internal ; Cerebrovascular Disorders ; Coloboma ; Constriction, Pathologic ; Eye ; Humans ; Moyamoya Disease

OBJECTIVE: To investigate the correlation of kinetic features of breast cancers on computer-aided diagnosis (CAD) of preoperative 3T magnetic resonance imaging (MRI) data and clinical-pathologic factors in breast cancer patients. MATERIALS AND METHODS: Between July 2016 and March 2017, 85 patients (mean age, 54 years; age range, 35–81 years) with invasive breast cancers (mean, 1.8 cm; range, 0.8–4.8 cm) who had undergone MRI and surgery were retrospectively enrolled. All magnetic resonance images were processed using CAD, and kinetic features of tumors were acquired. The relationships between kinetic features and clinical-pathologic factors were assessed using Spearman correlation test and binary logistic regression analysis. RESULTS: Peak enhancement and angio-volume were significantly correlated with histologic grade, Ki-67 index, and tumor size: r = 0.355 (p = 0.001), r = 0.330 (p = 0.002), and r = 0.231 (p = 0.033) for peak enhancement, r = 0.410 (p = 0.005), r = 0.341 (p < 0.001), and r = 0.505 (p < 0.001) for angio-volume. Delayed-plateau component was correlated with Ki-67 (r = 0.255 [p = 0.019]). In regression analysis, higher peak enhancement was associated with higher histologic grade (odds ratio [OR] = 1.004; 95% confidence interval [CI]: 1.001–1.008; p = 0.024), and higher delayed-plateau component and angio-volume were associated with higher Ki-67 (OR = 1.051; 95% CI: 1.011–1.094; p = 0.013 for delayed-plateau component, OR = 1.178; 95% CI: 1.023–1.356; p = 0.023 for angio-volume). CONCLUSION: Of the CAD-assessed kinetic features, higher peak enhancement may correlate with higher histologic grade, and higher delayed-plateau component and angio-volume correlate with higher Ki-67 index. These results support the clinical application of kinetic features in prognosis assessment.
Breast Neoplasms ; Breast ; Diagnosis ; Humans ; Logistic Models ; Magnetic Resonance Imaging ; Prognosis ; Retrospective Studies