BACKGROUND: Cytokeratins were subdivided into 20 different cytokeratins. It is known that cytokeratin 19 is particularly abundant in carcinoma of the lung. METHOD: A sandwich enzyme-linked immunosorbent assay called CYFRA 21-1, combining two monoclonal antibodies directed specifically aganist cytokeratin 19 was done by ES-300(Boehringer Mannheim, Germany). We investigated the diagnostic value of the new tumor marker CYFRA 21-1 in lung cancer in comparison to carcinoembryonic antigen(CEA) and neuron specific enolase(NSE) in the pilot study on 39 serum samples from lung cancer (17 squamous cell cancer, 11 adenocarcinoma, 11 small cell carcinoma) and 51 benign lung diseases and 41 normal healthy persons. RESULTS: Postulating a specificity 95% versus benign lung disease and healthy group, the diagnostic sensitivity of CYFRA 21-1 in lung cnacer independent of histologic type was 43.6% whereas CEA was 48.7% and NSE was 30.8%. The diagnostic sensitivity is increased to 69.2% by combining CYFRA 21-1 with CEA. Classifying the lung carcinomas following their histologic type, squamous cell carcinomas proved to possess the highest CYFRA 21-1 sensitivity(CYFRA 21-1 47.1%, CEA 23.5%, NSE 11.8%) and the combination with CEA 52.9% could not markedly increase the number of true-positive test results. In adenocarcinoma, CEA possessed the highest sensitivity (81.8%) whereas CYFRA 21-1 was 45.5% and NSE was 9.1%. In small cell carcinoma of lung, NSE possessed the highest sensitivity(81.8%) whereas CYFRA 21-1 was 36.4% and CEA was 54.5%. CONCLUSION: This study indicates that CYFRA 21-1 has a potential as a new marker for squamous cell lung cancer. If histologic type is unknown at the time of primary diagnosis. the combined determination of CYFRA 21-1 and CEA showed the best discrimination between benign and malignant lung disease.
Adenocarcinoma ; Antibodies, Monoclonal ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Diagnosis ; Discrimination (Psychology) ; Enzyme-Linked Immunosorbent Assay ; Humans ; Keratin-19 ; Keratins ; Lung Diseases ; Lung Neoplasms* ; Lung* ; Neoplasms, Squamous Cell ; Neurons ; Pilot Projects ; Sensitivity and Specificity

BACKGROUND AND PURPOSE: The claims data of the Korean National Health Insurance (NHI) system can be useful in stroke research. The aim of this study was to validate the accuracy of hospital discharge data used for NHI claims in identifying acute stroke and use of thrombolytic therapy. METHODS: The hospital discharge data of 1,811 patients with stroke-related diagnosis codes were obtained from Jeju National University Hospital (JNUH) and Seoul Medical Center (SMC). Three algorithms were tested to identify discharges with acute stroke [ischemic stroke (IS), intracranial hemorrhage (ICH), or subarachnoid hemorrhage (SAH)]: 1) all diagnosis codes up to nine positions, 2) one primary diagnosis and one secondary diagnosis, and 3) only one primary diagnosis code. Reviews of medical records were considered the gold standards. RESULTS: Overall, the degree of agreement (kappa) was higher for algorithms 1 and 2 than for algorithm 3, and the sensitivity and specificity of the first two algorithms for IS and SAH were both >90%, with almost perfect agreement (kappa=0.83-0.84) in the JNUH data set. Regarding ICH, only algorithm 1 yielded an almost perfect agreement (kappa=0.82). In the SMC data set, almost perfect agreement was found for both ICH and SAH in all three algorithms. In contrast, the three algorithms yielded a range of agreement levels, though all substantial, for IS. Almost perfect agreement was obtained for use of thrombolytic therapy in both data sets (kappa=0.91-0.99). CONCLUSIONS: Discharge with hemorrhagic stroke and use of thrombolytic therapy were identified with high reliability in administrative discharge data. A substantial level of agreement was also obtained for IS, despite variation between the algorithms and data sets.
Data Collection ; Dataset ; Diagnosis ; Hospital Records ; Humans ; Intracranial Hemorrhages ; Medical Records ; National Health Programs* ; Sensitivity and Specificity ; Seoul ; Stroke* ; Subarachnoid Hemorrhage ; Thrombolytic Therapy*

Management of urologic patients is being gradually but dramatically altered with new advances in technical innovation and refinements of interventional uroradiology. The broadening of indications for percutaneous nephrostomy became possible only after it was learned that it is a safe and effective means of establishing access to the renal collecting system. Percutaneous stone extraction (Nephrolithotomy) and Endopyelotomy are now well established procedures. These techniques have clear advantages over the surgical treatment for the same conditions and will increase the quality of patient care and reduce health care cost.
Human ; Kidney Calculi/therapy ; Kidney Diseases/diagnosis ; Lithotripsy ; *Nephrostomy, Percutaneous/contraindications ; Urinary Tract Infections/diagnosis/therapy

PURPOSE: To compare the differential radiologic findings of renal cell carcinoma presenting as a homogeneous solid mass (HS-RCC) and muscle-predominant angiomyolipoma (MP-AML). MATERIALS AND METHODS: Nine of 76 surgically and pathologically proven RCCs presenting at CT or magnetic resonance (MR) imaging as a homogeneous solid mass, and four cases of MP-AML were included in this study. Echogenicity at sonography, attenuation at non-enhanced CT (NECT), the contour of the mass, signal intensities at T1- and T2-weighted MR imaging, the existence of a capsule, and the pattern and degree of enhancement at CT and MR imaging were retrospectively analyzed. RESULTS: Two of five HS-RCCs were isoechoic and three were hyperechoic. Two of three MP-AMLs, however, were isoechoic, and one was mixed echoic. All nine HS-RCCs were round or oval in shape, but three MPAMLs were lobulated and one was round. At NECT, seven of eight HS-RCCs were isodense and one was hypodense compared to surrounding normal renal parenchyme, but three MP-AMLs were hyperdense masses and one was isodense. At enhanced CT, HS-RCCs showed various degrees of homogeneous enhancement, but all MP-AMLs showed moderate homogeneous enhancement. All three MP-AMLs demonstrated heterogeneous hypointensity at T2-weighted MRI and homogeneous hypointensity at T1-weighted MRI. HS-RCCs showed various signal intensities at both T1- and T2-weighted MRI, and in five cases, heterogeneous high signal intensity at T2-weighted MRI. Capsules were observed in seven of nine HS-RCCs but not in any of the three MP-AMLs. At enhanced T1-weighted MRI, MP-AMLs showed mild to moderate enhancement, but HSRCCs showed mild, moderate, and strong enhancement in two, two, and five cases, respectively. CONCLUSION: Echogenicity, density at NECT, signal intensity at MR T2-WI, the contour of the mass, and the existence of a capsule are features which are useful in the differential diagnosis of HS-RCC and MP-AML.
Angiomyolipoma* ; Capsules ; Carcinoma, Renal Cell* ; Diagnosis, Differential ; Magnetic Resonance Imaging ; Retrospective Studies

PURPOSE: To determine the detection rate of MRI in the diagnosis of adenomyosis and ascertain the accuracy of MRI in assessing the extent and depth of the myometrial invasion. MATERIALS AND METHODS: By retrospective analysis of MR images of the pelvis in 65 pathologically proven cases of uterine adenomyosis, we investigated the detection rate and differences of in the detection rate when this was based on (a) the extent, and (b) the depth of myometrial invasion. The condition was classified as diffuse or focal according to the extent of invasion, and mild, moderate, or severe according to its depth. RESULTS: Pathologically, there were 35 cases of focal adenomyosis (53.8%), and 30 of diffuse adenomyosis (46.2%). Among patients with the focal variety of this condition, 12 cases were mild, 14 were mild, 14 were moderate, and nine were severe, while among those with the diffuse variety, two were mild, ten were moderate and 18 were severe. A total of 48 cases (73.8%) were detected on MR images; the detection rate of focal adenomyosis was 60.0% (21/35) and that of diffuse adenomyosis was 90.0% (27/30). The detection rates of mild, moderate, and severe adenomyosis were 42.9%(6/14), 79.2%(19/24), and 85.2% (23/27), respectively. Among the 48 cases detected on MR images, the pathologic and MR findings were consistent with regard to both the extent and depth of myometrial invasion in 26(54.2%). For diffuse adenomyosis, the consistency rate was higher than for the focal variety (81.5%, 22/27; compared with 19%, 4/21). The extent of myometrial invasion was correctly evaluated in 32 cases (66.7%); the consistency rate for the diffuse form was higher than for the focal form [96.3% (26/27), compared with 28.6% (6/21)]. In 42 cases (87.5%), the depth of invasion was correctly evaluated, though differences in this depth were not significant. CONCLUSION: MR imaging was a useful imaging modality in the diagnosis of uterine adenomyosis. With regard to the extant of mymetrial invasion, the detection rate was higher among cases of the diffuse form than of the focal form, and with regard to depth, the rate was higher among moderate and severe cases than among mild ones. These findings may be useful for preoperative diagnosis based on clinical symptoms, and provide important yardstick for decisions as to whether hysterectony should be replaced by an alternative therapy.
Adenomyosis* ; Diagnosis ; Humans ; Magnetic Resonance Imaging* ; Pelvis ; Retrospective Studies ; Uterus

PURPOSE: To compare the mammographic features and histologic subtypes of ductal carcinoma in situ(DCIS) of the breast. MATERIALS AND METHODS: Mammograms of 34 patients with DCIS of the breast detected between January 1992 and November 1998 were retrospectively analyzed. Histologic subtypes were classified as either comedo or noncomedo. Mammographic findings were classified in one of four ways : microcalcification only, microcalcification with mass, mass or asymmetrical density only, or normal. Microcalcifications was classified as either predominantly casting or granular. We also determined whether microcalcification was multifocal. RESULTS: Histologic examination revealed the comedo type in eight patients and the noncomedo type in 26. Among the eight comedo-type cases, mammography demonstrated microcalcification only in five and micro-calcification with mass in three. Among 26 noncomedo-type cases, microcalcifications only was seen in ten, microcalcification with mass in two, mass or asymmetrical density only in six, and normal features in eight. Six of the comedo type were predominantly casting and two were predominantly granular. Predominantly casting calcification was present in four of 12 cases of the noncomedo type and predominatly granular was in eight. Multifocality was seen in four comedo-type cases, but in none of those that were of the noncomedo type. CONCLUSION: We conclude that the comedo subtype of DCIS of the breast is more likely than the noncomedo subtype to be accompanied by microcalcification of the predominantly casting type. Multifocally located microcalcification is a more frequent feature of the comedo subtype than of the noncomedo subtype.
Breast ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Humans ; Mammography ; Retrospective Studies

OBJECTIVE: To identify the correlation between change in spinal deformities after surgical release and age at the time of surgery, and the effectiveness of surgical release in patients with neglected congenital muscular torticollis (CMT). METHODS: This was a retrospective study of 46 subjects with neglected CMT who had undergone surgical release at age ≥5 years at a tertiary medical center between January 2009 and January 2014. Spinal deformities were measured on anteroposterior plain radiographs of the cervical and whole spine, both preoperatively and postoperatively, to assess 3 parameters: cervicomandibular angle (CMA), lateral shift (LS), and Cobb angle (CA). We analyzed the change in spinal deformities after surgical release in consideration of age at the time of surgery. RESULTS: The median age at the time of surgery was 12.87 years. All 3 parameters showed significant improvement after surgical release (median values, pre- to post-surgery: CMA, 12.13° to 4.02°; LS, 18.13 mm to 13.55 mm; CA, 6.10° to 4.80°; all p<0.05). There was no significant correlation between age at the time of surgery and change in CMA (R=0.145, p=0.341) and LS (R=0.103, p=0.608). However, CA showed significant improvement with increasing age (R=0.150, p=0.046). CONCLUSION: We assessed the correlation between change in spinal deformities after surgical release and age at the time of surgery. We found that that surgical release is effective for spinal deformities, even in older patients. These findings enhance our understanding of the effectiveness and timing of surgical release in patients with neglected CMT.
Congenital Abnormalities ; Humans ; Retrospective Studies ; Spine ; Torticollis* ; Treatment Outcome

Splenic infarction occurs when parenchymal ischemia of the spleen is evoked by an occlusion of the arterial or venous circulation. The most common causes include infiltrative hematological disease and thromboembolic conditions, but a hypotensive splenic infarction may be a rare cause of splenic infarction. A 62-year-old female patient presented with a hypotensive splenic infarction after massive bleeding. CT showed geographic low-density lesions in the central part of the spleen on the tissue equilibrium phase of dynamic CT. Usually, a depressed scar occurs in the course of healing of a splenic infarction. However, in this case recovery of blood flow and regeneration of the infarcted spleen was seen during the follow-up CT scans. We report a case of hypotensive splenic infarction with a review of the literature.
Cicatrix ; Female ; Follow-Up Studies ; Hematologic Diseases ; Hemorrhage ; Humans ; Hypotension ; Infarction ; Ischemia ; Middle Aged ; Regeneration ; Spleen ; Splenic Infarction* ; Tomography, X-Ray Computed

PURPOSE: Hypoxic myoclonus is usually a sign of favorable prognosis in cardiac arrest survivors. No single specific factor has yet been consistently predictive of myoclonus or status epilepticus accompanying post-cardiac arrest status. The aim of this study was to investigate characteristics and the predicting factors of myoclonus in patients who recovered from cardiac arrest. METHODS: A single center, retrospective study was conducted from January 2011 to December 2013. A total of 174 patients who were over 18 years of age and who survived longer than 72 hours after cardiac arrest were enrolled. Patients were divided into two groups according to the development of myoclonus. Individual characteristics, information related to cardiac arrest and post-cardiac arrest status, method of evaluation and treatment, and the Cerebral Performance Category (CPC) score were collected. RESULTS: Of all patients, 42 were assigned to the myoclonus group and 132 to the non-myoclonic group. Forty patients (95.2%) in the myoclonic group presented with generalized myoclonus. Asphyxia, as a presumed cause of arrest, was a statistically significant variable of myoclonus development after cardiac arrest (p=0.048). Initial arrest rhythm, laboratory test, and therapeutic hypothermia were not associated with development of myoclonus. The myoclonic group showed a significant tendency to increase the rate of poor neurologic outcome (CPC 3 to 5) compared to the non-myoclonic group (p<0.00). CONCLUSION: Asphyxia as a cause of arrest may be the single early predictor for development of hypoxic myoclonus in post-cardiac arrest patients.
Asphyxia ; Heart Arrest* ; Humans ; Hypothermia ; Myoclonus* ; Prognosis ; Retrospective Studies ; Status Epilepticus ; Survivors

Calcifying Fibrous Pseudotumor of the Retroperi We report a case of calcifying fibrous pseudotumor in theretroperitoneum. This is a rare soft tissue mass le-sion with specific radiologic and pathologic findings, and itis the first reported case arising in the retroperi-toneum. The CT, MR and angiographic findings are described.