No abstract available.
Risk Factors*

Parosteal lipoma is a rare and generally asymptomatic benign tumor of mature adipose tissue that is located in direct apposition to the external surface of the bone. These tumors are occasionally associated with reactive changes in the underlying bone. The reactive bone formation is generally restricted to the base of the tumor, that is, near the periosteum. We recently experienced a case of parosteal lipoma in the proximal femur, which displayed exuberant bone and cartilage formation, and this led us to a misdiagnosis of chondroblastic osteosarcoma on the initial biopsy. We report here on this case with a special emphasis on making the differential diagnosis from osteosarcoma.
Adipose Tissue ; Biopsy ; Cartilage ; Chondrocytes ; Diagnosis, Differential ; Diagnostic Errors ; Femur* ; Lipoma* ; Osteogenesis ; Osteosarcoma ; Osteosarcoma, Juxtacortical ; Periosteum

BACKGROUND: To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children. METHODS: Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation ≤ 5 prism diopters, or exodeviation ≤ 10 prism diopters at distance. RESULTS: Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 ± 2.19 years, and the mean duration of postoperative follow-up was 27.78 ± 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery (P = 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle (P = 0.027 and P = 0.022, respectively). CONCLUSION: Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important clues for predicting the final result of operation for recurrent X(T).
Child ; Diagnosis ; Esotropia ; Exotropia ; Follow-Up Studies ; Humans ; Methods ; Prognosis ; Reoperation ; Strabismus

Post-transplant lymphoproliferative disorder (PTLD) following solid organ transplantation is an important form of post-transplant malignancy. PTLD is typically associated with Epstein-Barr virus (EBV) and occurs in the setting of immunosuppression resulting in a deficiency of EBV-specific cytotoxic T lymphocytes. PTLD encompasses heterogeneous lymphoproliferative diseases, from polyclonal proliferation resembling infectious mononucleosis to aggressive monomorphic proliferation such as diffuse large B-cell lymphoma. Clinically, PTLD is usually manifested as lymph nodal mass or extranodal mass of solid organs such as liver, transplanted kidney, tonsil, bone marrow or spleen. The authors experienced very rare case of PTLD manifested as a single mass in a native kidney. According to a review of the literature, this is a rare case of PTLD which developed in a native kidney after kidney transplantation. Initially under the impression of renal cell carcinoma, unilateral nephrectomy of the native kidney had performed, and after confirmed as PTLD by histologic diagnosis the patient had treated with reduction of immunosuppressants and chemotheraphy for PTLD, and eventually has got in complete remission.
Bone Marrow ; Carcinoma, Renal Cell ; Herpesvirus 4, Human ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Infectious Mononucleosis ; Kidney ; Kidney Transplantation ; Liver ; Lymphoma, B-Cell ; Lymphoproliferative Disorders ; Nephrectomy ; Organ Transplantation ; Palatine Tonsil ; Spleen ; T-Lymphocytes, Cytotoxic ; Transplants

Gastric metastasis from breast cancer is rare and only six cases have been reported in Korea. Colon metastasis is more rare than gastric metastasis. We report a 63-year-old woman with gastric and colon metastases of invasive lobular carcinoma of breast. She was diagnosed as right breast cancer, received right modified radical mastectomy 10 years ago and has been treated with chemotherapy and hormone therapy. Investigating for melena and a small caliber of stool, we found gastric and colon metastases. The diagnosis of metastatic breast cancer was made through gross pathologic and immunohistochemistry staining. We report a case with gastric and colon metastases from breast cancer and a review of the associated six case reports in Korea.
Breast ; Breast Neoplasms* ; Carcinoma, Lobular ; Colon* ; Diagnosis ; Drug Therapy ; Female ; Humans ; Immunohistochemistry ; Korea ; Mastectomy, Modified Radical ; Melena ; Middle Aged ; Neoplasm Metastasis* ; Stomach*

A seventyone-year-old male presented with sudden epigastric pain followed by jaundice and intermittent right upper abdominal pain. He was diagnosed as hepatocellular carcinoma 7 years ago, and has been treated with transarterial chemoembolization, percuaneous ethanol injection and segmentectomy. On admission, the level of serum bilirubin, amylase and lipase were 8.7 mg/dL, 560 IU/L, and 13,297 IU/L, respectively. Stool occult blood test was positive. Abdominal computed tomography revealed newly-appeared intraductal soft tissue mass with ductal dilatation. Endoscopic retrograde cholangiography demonstrated filling defects in the common hepatic and distal common bile duct (CBD). Endoscopic sphincterotomy was performed and the clots in the distal CBD were removed. An intraductal stent was inserted at the common hepatic duct. The obstructive jaundice and pancreatitis were resolved. Our case suggests that intraductal hepatocellular carcinoma may induce hemobilia as a possible cause of acute pancreatitis.
Abdominal Pain ; Amylases ; Bilirubin ; Carcinoma, Hepatocellular* ; Cholangiography ; Common Bile Duct ; Dilatation ; Ethanol ; Hemobilia* ; Hepatic Duct, Common ; Humans ; Jaundice ; Jaundice, Obstructive ; Lipase ; Male ; Mastectomy, Segmental ; Occult Blood ; Pancreatitis ; Sphincterotomy, Endoscopic ; Stents

Choledochocele is a kind of choledochal cyst and represents a prolapse or herniation of the intramural segment of the distal common bile duct into the duodenal lumen. It is rare congenital anomaly and, easlily overlooked due to non-specific clinical symptoms, signs, and non-characteristic radiologic features. The cause of choledochocele remains uncertain and it was suggested that thete are two distinct types in the pathogenesis of it, i.e., congenital and acquired. Recently, many cases of choledochocele were reported, which diagnosed by ERCP and safely treated with endoscopic unroofing and EST followed by continued observation as well as interval ERCP and/or endoscopic ultrasonography. We present here four cases of symptomaatic choledochoceles that had been managcd by end- oscopic therapy and continucd observation.
Biliary Tract* ; Cholangiopancreatography, Endoscopic Retrograde ; Choledochal Cyst* ; Common Bile Duct ; Endosonography ; Pancreas* ; Prolapse

PURPOSE: Pseudomembranous colitis (PMC) occurs rarely in children, but its incidences are increasing due to frequent antibiotic use. We investigated the incidence and clinical characteristics of PMC accompanied by bacterial enteritis-like symptoms in children. METHODS: Between November 2003 and July 2007 at the Department of Pediatrics, Dongsan Medical Center, we analyzed the medical records of consecutive patients who received antibiotics in the past 1 month, developed bacterial enteritis-like symptoms, and were diagnosed with PMC based on sigmoidoscopy examination and histological findings. RESULTS: Among 22 patients who underwent sigmoidoscopy and biopsy examinations, 11 (50%) were diagnosed with PMC. These 11 patients were aged 2 months-12 years, among whom 5 patients (45.5%) were less than 1 year old. The clinical symptoms were bloody diarrhea (28.6%), abdominal pain or colic (28.6%), watery or mucoid diarrhea (23.8%), vomiting (9.5%), and fever (9.5%). The antibiotics used were penicillins (55.6%), macrolides (27.8%), cephalosporins (11.1%), and aminoglycosides (5.6%). The period of antibiotic use was 3-14 days. The interval between the initial antibiotic exposure and the onset of symptoms was 5-21 days. The results of stool examination of all patients were negative for Clostridium difficile toxin A. Patient distribution according to the degree of PMC was as follows: grade I, 18.2% (2 cases); grade II, 27.3% (3); grade III, 36.4% (4); and grade IV, 18.2% (2). PMC did not recur in any case. CONCLUSION: PMC is not a rare disease in children. If pediatric patients receiving antibiotics manifest symptoms like bacterial enteritis, PMC should be suspected. Endoscopy and biopsy should be applied as aggressive diagnostic approaches to detect this condition.
Abdominal Pain ; Aged ; Aminoglycosides ; Anti-Bacterial Agents ; Bacterial Toxins ; Biopsy ; Cephalosporins ; Child ; Clostridium difficile ; Colic ; Diarrhea ; Endoscopy ; Enteritis ; Enterocolitis, Pseudomembranous ; Enterotoxins ; Fever ; Humans ; Incidence ; Korea ; Macrolides ; Medical Records ; Pediatrics ; Penicillins ; Rare Diseases ; Sigmoidoscopy ; Vomiting

PURPOSE: To reveal the incidence and clinical manifestations of steroid-induced cataract, and to evaluate the visual outcome after cataract surgery in children. METHODS: We reviewed the charts of the pediatric patients who had been receiving oral prednisolone for at least one year and had visited the ophthalmologic clinic between January 1991 and December 2006, and enrolled the patients who had been diagnosed as having steroid-induced cataracts. We investigated the total dose and duration of medication and compared the visual acuity (VA) at the initial visit with that of the last follow-up. We also compared the pre- and post-operative best corrected visual acuity of the patients who had undergone cataract operation. RESULTS: Among the 1408 patients who had been treated with systemic steroids for over one year, lens opacities were found in 92 eyes (2.5%). The total duration and dose of medication were not significantly correlated with the VA (R2<0.1). The lens opacities were found bilaterally in 88 eyes (91.7%), and unilaterally in 4 eyes (8.3%). The posterior subcapsular opacities were the most frequent (84.8%). In 81 eyes who had not undergone surgery, there was no significant change of VA (p=1). The 11 eyes who had undergone cataract surgery showed significant increases in VA (p<0.01). CONCLUSIONS: The incidence of steroid-induced cataract in pediatric patients was 2.5%. The dose and duration of medication were not significantly correlated with the visual impairment. There was no significant change in VA during the follow-up. The surgical outcome of the cataract operation was favorable.
Cataract ; Child ; Eye ; Follow-Up Studies ; Humans ; Incidence ; Prednisolone ; Steroids ; Vision Disorders ; Visual Acuity

PURPOSE: To report a case of bilateral Coats' disease. CASE SUMMARY: A 19-month-old boy presented with esodeviation of his eyes, which started 5 months prior. A fundus exam showed total bullous exudative retinal detachment with retinal vascular telangiectasia in the right eye and localized exudative retinal detachment with vascular telangiectasia at the inferior periphery in the right eye. Fluorescein angiogram of the left eye showed retinal telangiectatic vessels, avascular area and fluorescein leakeage from telangiectatic vessels. The patient received external drainage of subretinal fluid and intravitreal air injection of the right eye and Argon LASER photocoagulation and cryotheraphy of the left eye. A cytologic exam of the subretinal fluid drained from the right eye showed no malignant cells. Forty-four months after the operation, his best corrected visual acuity was no light perception in the right eye and 0.4 in the left eye. Both fundi were flat and stable. No complications, such as glaucoma, recurred retinal detachment, or pain, occurred. CONCLUSIONS: Coats' disease rarely occurs bilaterally and can be involved asymmetrically. The disease presents more severely when bilateral and can progress after long-term observation. Proper treatment and long-term follow-up of both eyes are necessary to prevent visual loss and preserve eyes.
Argon ; Drainage ; Esotropia ; Eye ; Fluorescein ; Follow-Up Studies ; Glaucoma ; Humans ; Infant ; Light ; Light Coagulation ; Retinal Detachment ; Retinaldehyde ; Subretinal Fluid ; Telangiectasis ; Visual Acuity